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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.gov <br /> -Lb 01 SvAAc^ ( - A- ✓ <br /> PROJECT ADDRESS 4425-- 231 <br /> Zy ®r7 <br /> E✓eGesci✓ R-rcova2 Po . 650K 15 Crfa�Tr, <br /> � <br /> Owner Mail Address City State/Zip Phone <br /> M M O c,✓1"1-e--"es- <br /> Tenant Mail Address City State/Zip Phone <br /> QIFtc. F,'( 1 5cc.ap-ry '82$ eO CA-� 'L S . S ^^ 31 <br /> Electrical Contractor Mail Address City State/Zip 93((((f Phone <br /> tai ( Fr5cli `fM F `12rSy <br /> tate License Number(required) City of Everett Business License Number(required) <br /> icn <br /> COAhM C1AL 41000 . <br /> Proposed Use of Building Contract Price of Work <br /> ,-- X-0 SEP- viem(voAJ -29I— 'f 9 V 8 <br /> Square Footage(If residential new construction, remodel or addition) Contact Person/Contact Number/Email <br /> i .rV®Q �C rel'?Git,V'ti.COWt. <br /> Number of devices(If low voltage) 1 <br /> Description of Work to Be Done: Lt ICE Fd(1- Li l rr R...eQCAC C-A"E til' 0r- 7-14-6- <br /> rt <br /> 16ff 67 6-/2-"--- pit- E( . <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> /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 <br /> performance of construction. That I am auth• ized by the owner of this property to perform the E ( t g-07 <br /> work for which application is made and I c' •ly with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> ,-4gnature / Date <br /> REVISED 08/0812014 <br /> I t 3155 -Fa- We 6-K-e_ <br />