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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857— t v w - <br /> �'h,ar,�� � . .���;��r�.e�S � G t1,G'-t'r'-�`"0 �J� •q�1 � <br /> 2 Li 0 PE-0 <br /> PROJECT ADDRESS <br /> OwnerF[ � L-�i 1 �:•Z•J <br /> Mail Address City State/Zip Phone <br /> � ' .;1 <br /> Tenant Mail Address City State/Zip Phone <br /> I <br /> -TC <br /> 136 K `�L� 1,61 I� t�JlJ 11 ` 4L• 1 �� <br /> Electrical Contractor u'0 �S �`1 Z5 X22 2c� t Z <br /> Mail Address City State/Zip Phone <br /> State License Number(required) City of Everett Business License Number(required) <br /> n Off' <br /> • 2��r <br /> Proposed Use of Building Contract Price of Work <br /> Square Footage(If residential new construction, remodel or addition) . ContactPerson/Contact Nu ber/mail <br /> Number of devices (If low voltage) <br /> Description of Work to Be Done: CDS '=1-1L/(Tt Y 5"9V i N <br /> l <br /> t 141,j 1kz. ')S ! 2 C � cae IT <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> l hereby certify that/have read and examined this application and know the same to be Prue 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 l am authorized by the owner of this property to perform the E <br /> work for which application is made and/comply with the State Contractors Law 98.27 RCW and <br /> 296.200 WAC. <br /> Signature ` Date <br /> i <br /> REVISED 08/06/2014 t'G -70 / /� <br />