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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 /> 0 L(o LO M 13 nese A <br /> PROJECT ADDRESS <br /> 4-2--5' <br /> LLS cr7F' 1491 j1-CCC 13 ..x.1 .� L�-5 -� <br /> 1,02 b L b M - I-: cizr`j VW\a— 7 <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> i 'AA tA1 ' L---Li----t,71 C s5,7 Z`( i Do M y(elc laJ 0 11)1-- <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> C/ P ` A l� L— IJ 5 1 q I •• :. •e.. : i -EMKO ulQl f "- <br /> State License Number(required) City of Everett Business License Number(required) <br /> is Ov f L. L. AD I} ( T I O-'---, 1 b <br /> Proposed Use of Building Contract Price of Work LI V — ,L a- <br /> ++�� TC Cy LLz- <br /> Square Footage(If re idential new construction, remodel or addition) Contact Person/Contact Number/Email <br /> Number of devices (If low voltage) <br /> Description of Work to Be Done: W SII.h 4-D 0 1 '1'1 a-,--- <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 l <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 <br /> performance of construction. That I am authorized by the owner of this property to perform the E (c)e--7 <br /> V I <br /> work for which application is made and l comply with the State Contractors Law 18.27 RCW and <br /> 296;1 WAC. <br /> Signatur Date <br /> REVISED 08/06/2014 G L --( I {/1 <br />