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• <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 /> 34 / 2r x o/ <br /> PROJECT ADDRESS <br /> fie% S 'w, 3�o lietivergaI Coy rtia-eq2a3 - <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> soGi LLe cP//N w/93/o/SSa,o9 4 Ji'ke (AA,a " - A -4`/4/--/0/1 <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> .//Z/f)‹ coy )3?- <br /> State License Number(required) City of Everett Business License Number(required) <br /> r fez ,�. <br /> �7D <br /> Proposed Use of Building Contract Price of Work <br /> -7 I D00 <br /> CDA E PtiA'�°9" 86 235 foto.‘ <br /> Square Footage (If residential to truction, remodel or addition) Contact Person/Contact Number/Email <br /> Number of devices (If low voltage) <br /> Description of Work to Be Done: 1 /./ e � ��ely <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 415, 01)-- <br /> ,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 E 1 1 I <br /> work for which appli ation is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WA .. <br /> 7/1s/t0/5 <br /> Signature Date <br /> REVISED 08/06/2014 <br />