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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 /> s 3/0 ZAzdos7Ry Sr -C-/r,. 2d� <br /> PROJECT ADDRESS <br /> Owner Mail Address City State/Zip Phone <br /> e/�,A 7 P L� <br /> �, /3/U ��✓v,Ji7 Sr ,e-vifZCT7 ,92o 3 <br /> Tenant Mail Address City State/ZiptePhone <br /> /1- /14,7z24( LTL/C /729/13/s� �JIyvv �J �c .t .91). 7 `/Zs"77/79/G <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> idAirfrr osee-(0 <br /> tate License Number(required) City of Everett Business License Number(required) <br /> AereliVai la-e'- -"/' S OOO <br /> Proposed Use of Building Contract Price o Work <br /> d AM Progi yZ5 77' 79/6, <br /> 0/aveh@ham cam• C v'11 <br /> Square Footage(If residential new construction, remodel or addition) Contact Person/Contact Number/Email <br /> Number of devices (If low voltage) II <br /> Description of Work to Be Done: ST/?-i L. (''J SDA )N('4/F6Ae/J � (./.� /0OO,4 RaNiG00Ae0 <br /> 1-40/44 4-)CAS T77J�-, Strer//Ge <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 1 O (Q op <br /> I hereby certify that I have read and examined this application and know the same to be true and v <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 _ O <br /> performance of construction. That I am authorized by the owner of this property to perform the E H09 <br /> 1-17- <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> Signature Date <br /> REVISED 08/06/2014 <br />