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ot-i.saq <br /> ELECTRICAL PERIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, ERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257 8857 -www.everettwa.gov <br /> I <br /> I <br /> 0 Oct1,Ae3AvE <br /> • <br /> PROJECT ADDRESS <br /> .the cc e_5 <SOc/— Oa Ke S 4c)6 Cutom <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address `,/ City i f 1 State/ZipStPhone ? <br /> PA..—QCk 695+e Y -1-4'Jc. POP I.JU'J� 1395 1►1 at a)t 1� W A l J C q 375-7 73J <br /> Electrical Contractdr Mail Address City % State/Zip Phone <br /> Er <br /> .i") , a:_e._5 t 9 5 DB 0262-4 <br /> State License Number(required) ity of Everett Business License Number(required) <br /> Proposed Use of Building Contract Price of Work <br /> SO T )// 60,s--s3 76--isfi <br /> Square Footage(If residential new construction, remodel or addition) Contact Person/Contact Number/Email <br /> Number of devices(If low voltage) ,,n <br /> Description of Work to Be Done: 114.sh'�f/ Sc-u r' 4i -y...s "th l� Cr6 le'6r1/ �c* <br /> ,o a / j <br /> A rt, Co T-( LO j r 1 r9 <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 4 %le ^ �� <br /> I hereby certify that I have read and examined this application and know the same to be true and 1''3` <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 J�� <br /> performance of construction. T t l am authorized by the owner of this property to perform the E <br /> work for which application is ma e and I corn. frith the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> i'' / / <br /> / li, 0 109 )2/15---- <br /> it rd • to <br /> REVISED 08/06/2014 <br />