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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 425257-8857- www.everettwa.org <br /> PROJECT ADDRESS <br /> WI 0 - L4 . - Tr-t_ i i 0 , & - . 84t <br /> Owner Mail Address <br /> City State/Zip Phone <br /> Tenant Mall Address <br /> 1 ,� City State/Zip Phone <br /> L moi'-$'1 ' 0) +/IL L. t Luck-uck- 9 '8 1a8 .. . , . % 0 b <br /> Electrical Contractor Mail Address <br /> City State/Zip Phone <br /> g ka � DO a42 0 <br /> State License Number(required) City of Everett Business License Number(required) <br /> 1300 <br /> Proposed Use of Building Contract Price of Work <br /> Square Footage(If residential new construction,remodel or addition) ontact Person/Contact Number/Email <br /> Number of devices(If low voltage) <br /> Description of Work to Be Done: 0 tJXL / \.e.,s 3 U3 a- -- <br /> \(\.1 Ia.:kir- ....._______ <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 IT la De <br /> I hereby certify that I have read and examined this application and know the same to be true end <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 i(aO M 0 <br /> work for which application is made and i comply with the State Contractors Law 18.27 RCW and <br /> 1.200 WAC. <br /> ( I £.., _.&:;.__a ! • — _ LI ) 4 <br /> Signature <br /> Date <br /> REVISED 061/0612014 <br />