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L E C T R I Q8.L PE Pn,hd8 T A PPL�CAT�0H <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8830 - 'FAX 425-257-8857 -www.everettwa.org <br /> PROJECT ADDRESS <br /> C2e �sa5M Qr-a � �b 5r6AP4l(Gt/Ml 5 9 9 iQ4WA 98206 <br /> Owner �f Mail Address ity State/ZipRhone <br /> Tenant Mail Address City State/Zip Phone <br /> 'fz�' 3Sq-iq0-.. <br /> � M clyd rrc 60 f 3Ioo (� GE_C 6 5je 303 esms 6cao 6*11 l6�q�o�Z <br /> Electrical Contractor Mail Address City StateOp Phone <br /> I <br /> lel Q-jw-* <br /> State License Number(required) City of Everett Business License Number(required) <br /> at�A fze� V* z5tO." <br /> F"ropo ed Use of Building Contract Price of Work <br /> W000 41zs- 3S�-i902 <br /> Squar6 Footage (if residential new construction, remodel or addition) Contact Person/Contact Number/Email <br /> Number of devices (If low voltage) <br /> Description of Work to Be Done: <br /> exL 7�1�t11 C�C.I <br /> FEE , j <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <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 1 am authorized by the owner of this property to perform the I 1 CJ;) Lx <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 />