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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 /> 43-z7 Poll` Pic,cc___ <br /> PROJECT ADDRESS <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> On LLC- $-`sx5 39A/c, nl= Su.k t.34(3 2-I 1125-;05c-7325 <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> • <br /> IT Ft: ) ciCSI8N otI327 <br /> State License Number(required) City of Everett Business License Number(required) <br /> ►�-►�— 3i501> <br /> Proposed Use of Building Contract Price of Work <br /> ft.. 3 4.:0 <br /> Square Footag'(If residential new construction, remodel or addition) Contact Person/Contact Number/Email <br /> Number of devices (If low voltage) <br /> Description of Work to Be Done: Pr) o �� c,�cv^�S r,. ^� /Km) (5r,I Yn0-) L4.';, ash ) L-13^C, ` <br /> ort) Fc t),-i e. , CD A-r srj 6 <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 5 ( (/° <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 O l <br /> performance of construction. That I am authorized by the owner of this property to perform the t — `(/��,/, <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. /) <br /> Signature Date <br /> REVISED 08/06/2014 <br />