Laserfiche WebLink
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.gov <br /> g 3O . 0-111 ct S( , STh 100 <br /> PROJECT ADDRESS <br /> C/OVata96 M'1h9Q LL6 qV-K V 1f3ck Da- Los AiJ LEL OA q'QO3.6" <br /> Owner Mail Address S1E City State/Zip Phone <br /> Rak) MeDicAt, c100 ei>026 1 W4/ EVERETT IMA q8 04 Z77-a5,-1110 <br /> Tenant �Q Mail Address City State/Zip Phone <br /> LEER s o L L o bre. a se err IDA 4ega 20/f-80-4300 <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> tO0 Lf-Tz. 7if APIAfrei iNt6e/0—,/ <br /> State License Number(required) City of Everett Business License Number(required) <br /> Menicolt, SOAP." ISA#2GI-1F0t _ $, WO <br /> Proposed Use of Building Contract Price of Work <br /> N/A LEt: k s o LL 2.®cp--1317—(4z' <br /> Square 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: ) /s)STA Lt g R t,/NS (91 r 7r -0- ca,Imo e q Ac c SS' <br /> �4 t nrr V IJ ITS <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 Hr2^/ / <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 performance of construction. That I am authorized by the owner of this property to perform theE isbs-.DL1 <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> /\ ---1(e.;;;Ir" €1/3) <br /> Signature Date <br /> REVISED 08/06/2014 <br />