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ELECTRICAL ,IIIT A P?U CATIO <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 /> 470Z6 yb() r z--/J w/-i&,2 3 <br /> PROJECT ADDRESS <br /> Mack , 6 'F/e m.i n ,50-pi-e_ a-s , 12� - <br /> Owner $fail Address City State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> /i jerk e rhe m -/ 406. „r <br /> Electrical Contractor Vail Address City State/Zip Phone <br /> • <br /> State License Number(required) City of Everett Business License Number(required) <br /> ( ar <br /> Proposed �s 'of Building Contract Price of Work <br /> 'i3DZ s P <br /> Square Footage(If residential new construction, remodel or addition) Contact Person/Contact Number/Email <br /> Number of devices(If low voltage) <br /> Description of Work to Be Done: ti--063 i--AV / 1 6-P %s • <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 D� <br /> I hereby certify that 1 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 15 D q - ('g. <br /> work for which application is made and l comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> 7 I- -- ) <br /> "-- <br /> Signature -51-4/-Cji-'1/ Date <br /> REVISED 08/06/2014 <br />