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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—wonki.everettsw.org <br /> 76 t i 6v e,r- re en ft evere4 vV4 82,95 <br /> PROJECT ADDRESS <br /> Owner Mail Addmiss City State/Zip Phone <br /> Csctd . fiqz-q <br /> Tenant Mail Address city State/Zip Phone <br /> Prime- Eleatic 133oi t4D% Bellevue. (4) 'IWO% 424-741-svo <br /> Electrical ContractOt Mail Address City. State/Zip Phone <br /> en, <br /> MEEI 1'34 gr. S' 3 coo <br /> State License Number Contract Price of Work <br /> R e4-01.; I 'reiCe. <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 Dane: e p r arle4 e'er la Ce„ eve,ovi el, .2, ploy, "-Ince wro, <br /> • niti 6„vj b +404 ber : ' 111$ <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAx CODE 183105 <br /> hereby der*that I have read end examined/his application and know the Swim to be true and , <br /> correct All provisions of laws and ordinances governing this type of work will be completed <br /> whether specWed herein or not. The granting of a permit does not presume to rive authority to PERMIT <br /> violate or cancel the provisions of any other state or local law regulating construction or the <br /> performance of constnrction. That I am authorized by the owner of this property to perform the Elt01-1° 063 <br /> work for which application is made and I comply with the State Contractors Law 1827 RCW and <br /> 296,200 WAC. <br /> q —19 • <br /> ignature Date <br /> REVISED320/13 <br />