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From: 07/29/2014 10:50 4049 P.001/001 <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 /> &:les L-VCZE� ?IA--J-)- &1)6- �Q-3:S <br /> PROJECT ADDRESS <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address 'City State/Zip — "-_ — Phone <br /> t- -102>1 '4Z5-513-101 <br /> Electrical Contractor Mail Address City State/zip Phone <br /> (-OrjTQpZ Spm ! M7 >4/mo- 4 <br /> State License Number Contract Price of Work <br /> WI-Ut, !ang!j4-�00%a <br /> Proposed Use of Building Contact Person (Plan Review) <br /> Square Footage(If residential new construction,remodel or addition) <br /> Number of devices(If low voltage) <br /> Description of Work to Be Done: —~ (��J7/7.>� A- �FP��I C►4Gu(—I AtJ D 120%l CARCt3t T— <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 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 specirred 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 1 am authorized by the owner of this property to perform the b <br /> work for hich application is made and/comply with the State Contractors Law 18.27 RCW and <br /> 296.20 WAC. <br /> �► � Z 1 <br /> Signature ate <br /> REVISED 3/20113 <br />