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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 /> Lo 117���, <br /> PROJECT ADDRESS <br /> ra V o 4 e-rl+ WL 03 S 0 S a 3 <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> Lao 1012- S'- IA ke, 54-evens <br /> Ele trical Contractor Mail Address city State/Zip Phone <br /> E SLQe 0 16 �. <br /> State License Number(required) City of Everett Business License Number(required) <br /> L \\l �Y\ <br /> Proposed Use o Building Contract Price of Work <br /> �u4rk'c,k �38706 <br /> Square Footage(If residential new construction, remodel or addition) Contact Perso /Contact Number/Email <br /> Number of devices (If low voltage) <br /> pn � � <br /> Description of Work to Be Done: ►`�e�0 C cy� \Y\ <br /> m\C-� �vfo,ve� r If'r IT A�l�l;h�, �C _focv✓\ ce-cezajac <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 75 <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 or local law regulating construction or the E i 5 07 <br /> performance of construction. That I am authorized by the owner of this property to perform the v "� <br /> work for which application is made and l comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> ;t' 7z� <br /> Signature tDate <br /> REVISED 08/06/2014 <br />