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Aft <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 /> Z9 lb h3y'l- j'�v'E sot T �a <br /> PROJECT ADDRESS <br /> (-s— I8 �� S��'t ZZ30 1►�D�S��S� �y� ��32Q3 <br /> Owner—� Mail Address City State/Zip Phone <br /> '50;It Ate�- <br /> 0 S- 0 - 01ocot-Afm 2� 19 A\�� ��er�7` t/vi 2 O -ZZB - 0486 <br /> Tenant Mail Address City State/Zip Phone <br /> &L a-12,'c- 2q ZS IIb" Pi- r t,v - COMX25-82a-66a5 <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> State License Number(required) City of Everett Business License Number(required) <br /> WA A Nrl 10 , &oo <br /> Proposed use of Building Contract Price of Work <br /> k ` z2 -?70 6 � <br /> Square Footage (If residential new construction, remodel or addition) Contact Person/Contact Number/Email <br /> Number of devices (If low voltage) 0``^^ <br /> Description of Work to Be Done: �e IoCf},t- 2W 6k pG�Q� + `` 'F- <br /> A-m � � I Zu �,� <<2 c� T S fir' �•+�-�� �- ��'e� �'b� <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 `✓ /Q 00 <br /> 1 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 <br /> performance of construction. That I am authorized by the owner of this property to perform the E 0 6 <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> LiSi ature Date <br /> REVISED 08 6/2014 <br />