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10/21/2015 10: 19 4254133904 DIAMOND PAGE 02102 <br /> • Is <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425257-8857—www.everettwa.gov <br /> 6365-36"k cle. lcJ <br /> PROJECT ADDRESS <br /> Owner Mail Address city State/Zip Phone <br /> a iia �a�a S uK n Wm Fuere-� Lj-)-) 9k�D63 <br /> Tenant Mail Address ' City State/Zip Phone <br /> lC.Ct�d (Om M u.v�t rrk-i`CX15 Le &)'k i oa %Aas <br /> Electrical Contractor Mail Adtlress city State/Zip Phone <br /> �w tit oc� <br /> 8186j- C,)5 3 5c-f 5 <br /> State License Number(required) City of Everett Business License Number(required) <br /> mare-,k6u e- 3, SSU <br /> Proposed Use of Building Contract Price of Work <br /> U�(-�- �� tk,Lr yas�3al�c .g <br /> Square Footage(If residential new construction, remodel or addition) Contact P son/Contact Number/F-mail <br /> 16 Leckym6-) <br /> Number of devices(If low voltage) e- <br /> Description of Work to Be Done: cmmtko a coJ M - <br /> �rc1:�na 5� �,.�►<�� - r bac bc1►-�P 'n ��� `�(�— <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 5 D 0 <br /> I hereby certify that 1 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 /> whBther specified herein or not. The granting of a permit does not prosume to give authority to PERMIT# <br /> violate or cancel the provisions of any other state or local law regulating construction or the <br /> performance of construction, That/am authorized by the owner of this property to perform the E (ij( O - I rJ l <br /> work for which application is made and!comply with the state Contractors Law 98.27 RCW and <br /> 296.200 WAC. <br /> A <br /> signature 14 <br /> bate <br /> REVISep 08/062014 <br /> I <br />