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Jun 23 15 11:28a p.1 <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—vuvm.everettwa.gov <br /> PROJECT ADDRESS <br /> i <br /> e , bndreuz <br /> Owner Mall Ad ss <br /> COY State/Zip Phone <br /> Tenant Mail Address CRY StatelZip � Phone <br /> S L' i�I nl '(✓ LI 4 b5 1103 2,t> jf05 q62j--5 3 <br /> LeTER <br /> Electrical Contractor Mail Address City StatslZip Phone' <br /> TZ.DB6 E-r �L i [ lg� b o o:�, 514 <br /> State License Number(required) City of Everett Business License Number(required) <br /> _ '�3 -j bDp, atm <br /> Proposed Use of Building Contract Price of Work <br /> 00 IIx <br /> � <br /> Square Footage(If residential new construction, remodel or addition) Contact Person/Contact NumberlEmail <br /> Number of devices(if low voltage) <br /> Description of Work to Be Done: l <br /> FEE <br /> CITY OF EVERETT LOCAs: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 lJV <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 focal law regulating construction or the <br /> performance of construction. That I am authorized by the owner of this property to perfnmm the E j cj o „_l-76 <br /> work for which application is made and I comply with the State Contractors Law 16.27 RCW and !! �!/ <br /> 296.200 WAC. <br /> � la3 j.5 <br /> Signature Date <br /> ft V)SED 06,05/2014 <br />