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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.gov <br /> i-ivy I A' <br /> PROJECT ADDRESS <br /> rte - E-vE2 CL1C_ y005 i-loy T /ave f —;- wA '( $ort Liz s339/4-!2 c <br /> Owner Mail Address City State/Zip Phone <br /> EvE/2. .i� CLUJ YYOf t-10yi A\M 13.1V CIAT WA- ort `!Z5- Z59 (162- <br /> Tenant Mail Address City State/Zip Phone <br /> T1=AM NIL��\AN)i Cry L j2c. 1301C 7 81 MONAcZ- 98Z7 L 3(C 3C5l€3 35-- <br /> Electrical <br /> SElectrical Contractor Mail Address City State/Zip Phone <br /> �AM.�1I ac-3 "ic C536Sj� <br /> State License Number(required) City of Everett Business License Number(required) <br /> /A-r2-cD c_v6 1.3cc, a d <br /> Proposed Use of Building Contract Price of Work <br /> 51-EVccM(-6 -24',6 39 . 86`1$ <br /> Square Footage(If residential new construction, remodel or addition) Contact Person/Contact Number/Email <br /> S'TiTYP_,'t'fiq uMTk4lAn1:CAL. FA-AN/711V-•‘-C,-44 <br /> Z rV C W <br /> Number of devices(If low voltage) <br /> Description of Work to Be Done: /ZLLc(- X\Z 6 .T 5-(-0.7C , it STALL- Z /.. t'( TS-CAS-CS <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 �O ) <br /> I 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 I , <br /> performance of construction. That I am authorized by the owner of this property to perform the E <br /> work for which application is made and 1 comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> Signature Date <br /> REVISED 08/06/2014 <br />