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ELECTRICAL LI ATl <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 /> Ol C6Ib ,/ Ste 'Z <br /> PROJECT ADDRESS <br /> Owner Mail Address City State/Zip Phone <br /> A i.QUO ey 3 s o( Cn I b�Z 9T,,Ap, Wlk 92)201 L360 66y -bI1 73 <br /> Tenant Mail Address City State/Zip Phone <br /> T71AHt- 5 Z-1 1= \Jlc-7w,-t pbv" ti 011 b0A <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> t1JA 1-11)AHLC�c-7 2(,00t? 63 -7C) 'z `l <br /> State License Number(required) City of Everett Business License Number(required) <br /> j 2-7Z S 00 <br /> Proposed Use of Building Contract Price of Work <br /> Square Footage(If residential new construction, remodel or addition) Contact Person/Contact Number/Email <br /> Number of devices (If low voltage) <br /> Description of Work to Be Done: Ce r-Ui-C4- I f-o Cotp,ers (Po")'- r t r cc-1/1'1 Fo ���,�J3✓ <br /> P <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certify that I have read and examined this application and know the same to be true and <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 orlocal law regulating construction or the E I J <br /> performance of construction. That I am authorized by the owner of this property to perform the <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> —JR� )V� lupie- 36 20?5 <br /> Signature Date <br /> REVISED 08/06/2014 <br />