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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.org <br /> .30 3 19e3+- i„ %ct 514,4 40 - f' <br /> PROJECT ADDRESS <br /> Of iv j PO 3oX 3101 5-€4It. WA &a/z .1 <br /> Owner Mail Address City StatefZip Phone <br /> • <br /> - I til <br /> Tenant Mail Address City State/Zip Phone <br /> Irirv1e. Ek 4, 13301 5 2.6r1 Bellevue_ IAA too5 42.9.141-6700 <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> pomf I34 gr. ! 2 2 , 0 of <br /> State License Number Contract Price of Work <br /> Proposed Use of Building Contact Person (Plan Review) <br /> Square Footage(If residential new construction,remodel or addition) <br /> 6 <br /> W V <br /> ............................................. <br /> Number of devices(If low voltage) 'I,��^ <br /> Description of Work to Be Done: CO (x VC/r S e n Y ei r0O p-i 4-0 <br /> ki+I fut.Mcf•l41 -roov�, . 10 2..1561 C Z <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 \1 5 77 tp� <br /> I hereby certify that!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 pERmrs# <br /> violate or cancel the provisions of any other state or local law regulating construction or the �� <br /> performance of construction. That am authorized by the owner of this property to perform the j <br /> work for which application is made and I comply with the State Contractors Law 98.27 RCW and 1 <br /> 296.200 WAC. <br /> ////E/t,a 15 S. <br /> Signature Date <br /> REVISED 320113 <br />