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To: City of Lacey Page 3 of 3 2014-09-19 22:41:14 (GMT) 12532690268 From: Eric Olsen <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 /> PROJECT ADDRESS <br /> �h,tk 1 (0940 F&rF Cent- W4 �.k 3 s�� ��.+ F� �ti'� �1fs lY 9, <br /> owner Mail Address City State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> W��shtw� n ���5 �I lint Lti'A �T�'e�3� 15-5 <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> F L L)LS Lct3�(' \^ 04(o1,.0"�— <br /> State License Number(required) City of Everett Business License Number(required) <br /> of U� 0 <br /> Proposed Use of Building Contract Price of Work <br /> ��� �� ��SE,� �53 t✓� �7 J� Sa. JOtsc,�ete, n� <br /> Number of devices(If low voltage) <br /> Description of Work to Be Done 4�2'yy U � r U+C V-U ( \RC1 Vl\:/1 c? 47c%( <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certify that/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 <br /> work for which application is made and I comply with the State Contractors Law 18 27 RCW and <br /> 296.200 WAC. <br /> ZI q hl <br /> gnatur / ate <br /> REV/SED 0810612074 <br />