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Mar, 13. 2015 1 : 15PM No. 0516 P. 1 <br /> • <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--19"03 <br /> PROJECT ADDRESS <br /> Ci-e) / 0 07 `--m-s r-19 I 1/114 ;-r/014 <br /> Owner Mall Address City State/Zip Phone <br /> Tenant ail Address City6 ,9 State/Zip Phone <br /> Elect ral Contractor Mail Address City State/Zip Phone <br /> State 'cense Number(required) City of Everett Business License Number(required) <br /> 61/14 11 oil.Prop Building Contract Price of Work <br /> /61 C l <br /> Square Footage(If residential new construction,remodel or addition) Contact Pers t/cont t N tuber/Email <br /> 1 - ( 116 5/ <br /> Number of devices(If low voltage) <br /> '747L a�� <br /> Description of Work to Be Done: l.fP; j-1-4 rem o <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 1 (L 62- <br /> I <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 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 authorized by the owner of this property to perform the E1603— °(°1 <br /> work for which application is made and 1 comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> ; a <br /> Slgnattl - a �11/ <br /> f <br /> REVISED 08/08/2014 1 Y/ca <br />