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Ah <br />Ah <br />v <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 />cUrn- KRE cnc W)01y <br />PROJECT ADDRESS <br />n4Lr"F �r� +v PA-rz.TT <br />Owner Mail Address City Stale/Zip Phone <br />Tenant Mail Address City State/Zip Phone <br />,vG — <br />iw4 �I viz �57Zz <br />Sf�r��/r -nyl�e �r7y 3 S� 3�// - �� <br />Elecfrical Con4ractor Mail Address City State/Zip Phone <br />S; A14-/5 oi3 L. i 0K6CES5 <br />Slalb License Number (required) City of Evered Business License Number (required) <br />P1--k ra- , l z"/l UJ � <br />Proposed Use of Building Contract Price of Work <br />6R,t sd-✓ taD613 4/ Z 2Co <br />Square Footage (If residential new construction, remodel or addition) Contact Person/Contact Number/Email <br />Number of devices (If low voltage) r7 p <br />Description of Work to Be Done: VP p(af-e_ L' Ar ,-� S -OMB^ w' <br />CAN hz r Pn J .e <br />FEE <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 D /1 <br />1 hereby certify that I have read and examined this application and know the same to be true and VV <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 />vinlate 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 ' �2 Q 1 — r <br />work for which application is made and ' • mply with the State Contractors Law 18.27 RCW and <br />296.200) WAC. <br />SignatUY6 Date <br />REVISEDOM2014 <br />