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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 /> €5-61 Cot,.R k AQ.. <br /> PROJECT ADDRESS <br /> ryiCc C IAA A-NA{(Z-m&,T 70LO i ter q-)6 k)& C-Zo i (A �s"rl <br /> ''' � t3.el(euU� WA �g00`� [ Goy <br /> Owner Mail Address City State/Zip Phone <br /> 4(V'i Ivow . <br /> Tenant Mail Address City State/Zip Phone <br /> ua6 r3c T <br /> S2 crn (. -i3ltocn I ci t ZZ'vElLrr "AUE.#I7.0 c oeee cop.. q 3 16 1 62-5-1 <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> eC e—OC-2q 4}q Dc) o 5 360 .5--- <br /> State License Number(required) City of Everett Business License Number(required) <br /> Aprne ►-ii. 4iaSL� ,vU <br /> Proposed Use of Building Contract Price of Work <br /> 3--eK BeQ AeD-tt 5-3(3--5-.2g4 <br /> Square Footage(If residential new construction, remodel or addition) Contact Person/Contact Number/Email <br /> LAP c( <br /> Number of devices (If low voltage) ,� <br /> Description of Work to Be Done: i(.1JAr) c-I t ctQ-G -1s.,(- Arc' `j srJ./177 <br /> FEE / ll` <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 �T `11 V / J <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 I am authorized by the owner of this property to perform the E - ' I <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> id/445,--. <br /> Si ature Date / <br /> REVISED 08/06/2014 <br />