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3 of 3 08/11/2014 <br />PH <br />ELECTRICAL PERMIT APPLICATION <br />CITY OF: EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, Wi r 98J01 <br />125-257-8810 - =AX425.257-8857-www.eve,ettwa.urg <br />C-)4D0-06 z <br />Sai 9004 .57. <br />PROJECT ADDRESS <br />}/J�Pi(�ATSNorrCfA/1K 5,2/4c74,rrXed <br />ogdcx-&r! <br />c± 9&9 YS�aS-�d�7S-i <br />Comer Mail Address <br />City <br />9tatarrip <br />Phone <br />Tenant Mail Address <br />City <br />Stata2lp <br />Phone <br />4H.Oe--,O �54Een6a- 18,dOX F68 gvgFoeAr7— <br />u�9�P��1d6 <br />4�r--- 3-dY <br />Electrical Contractor Mall Address <br />city <br />Slatalzip <br />Phone <br />A.Al e/9e// 9e?-/5 <br />fate License Number t <br />Contract Price of Work <br />Proposed Use of Building <br />Square Footage (II residential new construction, remodel or addlgon) <br />Number of devices (It low voltage) <br />Description of Work to Be Done: <br />—4-GCS <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />Contact Person (Plan Review) <br />I hereby certify that I have mad and examined this application and know the same to be tmo and <br />correct. All provisions of laws and ordinances 9011eming this typo of work will be completed <br />whothor specifiod hereto or not. The granting of a permit does not presume to give authority to <br />violate or cancel the provisions of any other state or local law regulating construction or the <br />performance of construction. That I am authorirod by the owner of this property to perform the <br />work for which application is mode and I comply with the State Contractors Lew 18.27 RCW and <br />296200 WAC. <br />O - r-1 <br />Rv SW WW) <br />FEE <br />5009 <br />PERMIT# <br />EIyDB-O(Q2 <br />