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'"w' <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857—www.everettwa.org <br /> No-� '51� rnlerA Nil LOW <br /> PROJECT ADDRESS <br /> euo�c* t% 6-brW AV4?5-}e-Say Jf/V'np CA 1?(012 <br /> Owner Mail Address City State/Zip Phone <br /> -n-veno iso ->k eupt44 n1i LVV -,j I-15- �fyfle bA 16?oo <br /> TenantN. Mail Address City State/Zip Phone <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> I�(gf n)l- 9-1 -'-�z Oi-lw17 <br /> State License Number(required) City of Everett Business License Number(required) <br /> ��L <br /> Proposed Use of Building Contract Price of Work <br /> K IA t4eal4vr 40a 906-03- <br /> Square Footage(If residential new construction, remodel or addition) Contact Person/Cont ct Number/Email <br /> 04ic, Q7&-4 t-hY�)V- 'C4ue5+•LC'rl <br /> Number of devices(If low voltage) I/ r L,,V 1 n /) ) <br /> Description of Work to Be Done: I k4hjT 1'0/0 0 v ( � k111a <br /> �G n✓l>21 - � � C�C�i Q�'1C� � 1 �� lr�tG�� <br /> t (U, <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 / ®0 <br /> 1 <br /> l hereby certify that I have read and examined this application and know the same to be true and ►�J <br /> correct. All provisions of laws and ordinances governing this type of work will be completed <br /> whether specified herein or not. The granting of a permit does not presume to give authority to PERMIT# <br /> violate or cancel the provisions of any other state or local law regulating construction or the D� <br /> performance of construction. That I am authorized by the owner of this property to perform the i <br /> work for which application is made and 1 comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> Signature Date <br /> REVISED 08/062014 <br />