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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—www.everettwa.org <br /> 300-3 w-e stQ h1n nak 6le-JR &&d: Ireptoy i3l� `f O-3 6 goo( �--� <br /> PROJECT ADDRESS <br /> to e- o o 3 cj,�4--- C� 'Aj A toy <br /> Owner Mail Address City State/Zi` Phone <br /> ?)UCAZ • <br /> Tenant Mail Address City State/Zip Phone <br /> a fitw <br /> D o,1,a -e#%_ brahlexi LKS c!v 9=tti Luk , 4' A.Z 03 d,0621A.9523 <br /> Electrical Contractor ail Address City State/Zip Phone <br /> 1)1Zn .51 iE> 19 9'I yo An <br /> State License Number Contract Price of Work <br /> L qA5 ass(_ <br /> ZX mea.v f-.efo�'e- ka A- IC T1 s!v-P I ldft-9 <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: e,6%,LiC _ l_c3iVCr 7r! [_1��1 G1A.t1L !lA �PCti <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certify that/have read and examined this application and know the same to be true and tJ <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 1 am authorized by the owner of this property to perform the E 1 4�1 ®� <br /> V�-Uq�0 —1 <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 29AC. <br /> e��7 <br /> -.4 J <br /> _,� . c <br /> igna a Date <br /> REVISED 3/20/13 <br />