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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.gov <br /> VW Meq,0� <br /> PROJECT ADDRESS <br /> Owner Mail Address City State/Zip Phone <br /> LM-1 AemyeL�— I-1 tee /tri 11 Creek PkwH , ere Wk 9 X1,03 LAb-D 175:0 <br /> Tenant Mail Address City State/Zip Phone <br /> 61'1(G .L. ©VSec-,*C 8ZS PcVk� 1' 5 Sep,-'"-e- QA 18144 ZM-1$9-311H <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> 6M E &3 Q� 12-cx§ <br /> State License Number(required) City ofEverettBusiness License Number(required) <br /> AAAA 0d <br /> Proposed Use of Building Contract Price of Work <br /> Tek UZS-D 7, - �Tn <br /> Square Footage(If residential new construction, remodel or addition) Contact Person/Contact Number/Email <br /> Number or uevices(If low voltage) �] <br /> Description of Work to Be Done: T►��5 1 l \7,0 V <br /> 0\1 <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> /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/am authorized by the owner of this property to perform the E ' t k <br /> work for which application is made and/comply with the State Contractors Law 18.27 RCW and <br /> 296.200 W <br /> Signature Date <br /> REVISED 08/0612014 <br />