Laserfiche WebLink
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.gov <br />021 ic�a <br />PROJECT ADDRESS <br />�/t� L1nr�'i N! elllc,� �I'o21 �od��� �v� �G�/��'�" l�1Pr °� �2o Q (�12s)3y5 -`�� <br />Owner Mail Address City . State/Zip Phone <br />—�'_ <br />Tenant <br />Mail Address <br />City <br />State/Zip <br />Phone <br />W Q��2,� n Sb�C�' �I 0�11 ��onr�4'Zd S'fitLf� �Q�la �1�m I.LSi� �1�522(p <br />EleCtriCal Contractor Mail Address City State/Zip Phone <br />r. c vv�s ��s ��ti� i o � 5'� � s5 <br />State License Number (required) City of Everett Business License Number (required) <br />���c�.r �� — `_� , �S� r,�.e� � 2, �l y 6 <br />Proposed Use of Building Contract Price of Work <br />Squar`e Footage (If residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />-�vi c �1 �fi2 (3(�0�22�1-�1�53� <br />Contact Person/Contact Number/Email <br />2r1 �- C V�f2 S��r'l�c�GG�✓1 �'iL . CtX <br />Description of Work to Be Done: (� YjGi=ti Q1, Y'O�7 czS��Q-r � S\eSfi�.1'Y� - ID (!1C_� Uci� � <br />2. 9) I� Z�O �� �1'1 a ci u� <br />0 ) �V 152oc��! � -;-i� e� s-fi�-i <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />.� n,��.��� <br />I hereby ceriify that I have read and examined this applicafion and know the same to be true and <br />correct. All provisions of /aws 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 <br />violate or cancel the provisions of any other state or local law regulating construction or the <br />performance of construction. That I am authorized by the owner of this property to perform the <br />work for which application is ade and I comply with the State Contractors Law 18.27 RCW and <br />296.2�� w�:� � � <br />� <br />�� �l� ( <br />Siqnature Date <br />REVISED 08/O6/2014 <br />FEE <br />�D v� <br />PERMIT# <br />E I���'l� <br />