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ELECTRICALPERMIT 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 /> 3L o s 6Zo&effli' e <br /> PROJECT ADDRESS <br /> £taih2 ALU <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> • <br /> 74 kid('re 1.e, ,f\f-c& WO' CW.i-- cymite44-61\)11 cri WA 11* <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> State License Number(required) City of Everett Business License Number(required) <br /> Proposed Use of Building Contract Priceof Workor <br /> ) �.y <br /> Square Footage(If residential new construction, remodel or addition) Contac <br /> Z Person/ ntaQt.Numb r/E ailLWaeee i <br /> Number of devices (If low voltage) <br /> ., <br /> Description of Work to Be Done: moth <br /> . dri+ v tf.P� v" l/'Yv Y <br /> 7 / <br /> fp 4006t,hia l20ib v <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3106 7r 00 <br /> I hereby certify that I have read and examined this application and know the same to be true and l J <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 1504 - 1 ( U <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 W . <br /> • <br /> • 1//7-077.4/1- <br /> Signature Date <br /> REVISED 08/0612014 <br />