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r <br /> N <br /> , \‘‘ o <br /> l <br /> ELECTRICAL PERMIT APPLICATION I ,p <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 /> .21 30 Wta.Plc 5+ <br /> PROJECT ADDRESS <br /> G,,o�-``''�...��1�_ 'Go <br /> -Dormer Mail Address Qty Sfelerl, Phone <br /> G.D.A.kt Pk ION G I <br /> Tenant Mao Address City Stale/Zip Phone <br /> Prime. &lecki 13301 SE Zc*'i ST Bellevue. wA 9'5 Lin-7,11-570D <br /> Electrical Contractor Mat Address City State/Zip Phone - <br /> PEIMFE1t34 BT. .t 3, SS Z <br /> State License Number Contract Pike of Work <br /> /4 er,I•.1^ Co..rt. I <br /> Proposed Use of Building Contact Person(Plan Review) <br /> 1 <br /> Square Footage(lf residential new construction,remodel or addition) i <br /> Number of devices(If kw/voltage) <br /> A <br /> I <br /> Description of Wont to Be Done: A e 18CO�e (1) •0 -..H.# Z0 8 ✓ cfN'i pnvre(' <br /> c_.rci..rt —,.....1- —.LC C 2.) AR-1 LO a.'.+p 120 v vrcti)if <br /> Farr sire Sit,rmiler N r10 1,11 6IC677O. <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 t�vt '0 0 <br /> I hereby certify that/have mad end examined this application and know the same to be hue and t 1 <br /> coned Al provisions of laws and ordinances governing this type of work wrt be completed <br /> whether nedfied herein or not The granting of a permit does not presume to give authorityto ',emu , <br /> violate or cancel the provisions of any other state or local law regulatingof construction or the 1J�' l Or Dl/ <br /> performanceconstruction. et i am authorized by the owner of this property to perform the L.� v . <br /> work forwtrich epplcaton is made and I comply with the State Contractors Law 18.27 RCW and <br /> 2618.200 WAC. <br /> d/I/1S <br /> -//%�/ / tDate <br /> Signature <br /> 1 <br /> ROWED 370131 <br />