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1 <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 /> qe) 66 etox-614- mg ) ) ,Jf <br /> PROJECT ADDRESS <br /> ( H <br /> 1_/ Y::904 Po et,( ° kg°‘-/, V - - /1;PP1Ac "WU jr <br /> Owner Mail Address City State/Zip Phone <br /> *tf\th7!7'7 <br /> Tenant Mail Address City State/Zip Phone <br /> NdkiveSi-WK'nl Jf/ iu Ofee 26148/1 6694-'4*/ <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> 1SD k-1-1-1.6 1 g gi2-1) tasoq <br /> State License Number(required) C. of Everett Business License Number(required) <br /> kl—Filj <br /> 0D <br /> Proposed Use of Building Contract P ice of rk <br /> ti f <br /> .. , OAK) b " fp diSI4 0x-( <br /> Square ootage(If residential new construction, remodel or addition) Con01 <br /> Person/ ontact Number/Email , �' /A <br /> MMf G> flt S <br /> 'T <br /> umber tif devices(If low voltage) <br /> / / <br /> Description of Work to Be Done: . / *`f <br /> kirr' ....../ ,//JI � r/ / /L1 1=r As <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 611.V_ <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 specifie. erein or not. The granting of a permit does not presume to give authority to PERMIT# <br /> violate or cancel th-provisions of any other state or local law regulating construction or the �O�f <br /> performanc of o struction. That I am authorized by the owner of this property to perform the <br /> 2o I <br /> work for w h !pp.lication is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 C./ <br /> S-0244,--/8 <br /> Signature Date <br /> REVISED 08/06/2014 <br />