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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 /> 3O?5 L� ty h i1 i-�,l /-41-'-e-- Et/erre (.6)0 cga©/ <br /> PROJECT ADDRESS <br /> • <br /> I`IL(((( 0 ELfev'e r'Ve v W - 'fool <br /> Owner Mail Address City State/Zip Phone <br /> FVeArdt 5e 4 i o v (eerierr�e� Cela, dao/ <br /> Tenant Mail Address City State/Zip <br /> (3o,)9lo one <br /> �hv10 <br /> Av 4 ellrk ,c7y4 dot, ) aJ/UE OtiltQ < V.5 <br /> Electrical Contractor Mail Address City State/ZipPhone <br /> Povtl? ?.9-7 vv rya SS <br /> State License Number(required) City of Evere Business License Number(required) <br /> C ,677949° — <br /> Proposed Use of Building Catract Price VorK )10-66- <br /> 10 <br /> Square Footage(If residential new construction, remodel or addition) Contact Person/Contact Number/Email <br /> Number of devices (If low voltage) <br /> LJ Pew l/' ,�/ r • t <br /> Description of Work to Be Done: !/" ef;f9� t9 ee `fid obted Litv <br /> ivt_ blew <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 -1 SI <br /> 105 ' SI t)I hereby certify that I have read and examined this application and know the same to be true and <br /> l t �' <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 _ rl <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and V <br /> 296.200 WAC. <br /> ////,40. - <br /> Signature Date <br /> REVISED 08/06/2014 <br />