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• <br /> 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 /> LSI Shy--0-7P <br /> 3 —! 5 <br /> 1{-o I- <br /> PROJECT ADDRESS <br /> 70 i 3-1.Z1 <br /> Ute' A-712- (,-C*- (t31 <br /> Owner Mail Address City State/Zip Phone <br /> Gtr - t? , ) 7 �1;✓ U,,,� f;iAGti7i5—&G,q,,-1,1 23(, <br /> Tenant Mail Address City State/Zip Phone <br /> rr� <br /> V\J1N o li: l�✓+. r2:• CJ \t; j4 => li ,� i V14-T31;(7 <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> Jv7 .l i , 7 <br /> � <br /> State License Number(required) City of Everett Business License Number(required) <br /> i NDV��('G-�l.. '�,:(i✓-v G- ����"t �lJi tom$ y.1�r� � , � t <br /> Proposed Use of Building Contract Price of Work <br /> Square Footage(If residential new construction, remodel or addition) Contact Person/Contact Number/Email <br /> L r <br /> �IaA.a{�Ll �CiVI, 9iiL2�t�^v9/)O1O •SIM <br /> Number of devices (If low voltage) <br /> Description of Work to Be Done: ;/�F <'�% 4i, '�' i= .� i� i ` 7 i�TE c '_ <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 00 0 <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 <br /> performance of construction. That I am authorized by the owner of this property to perform the E15 09— 07g. <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 (A <br /> Sjal <br /> , , 13 (moi <br /> .i i` /l <br /> 01;11 ��i <br /> - <br /> \PT �' Date <br /> REVISED 08/06/2014 <br />