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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 /> C 2 Rocke. EeLt ,eg <br /> PROJECT ADDRESS <br /> fir LAt11 Li/ Fe fL . 2i f%O2 got f: e2 ti-ek:0-r <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> � A g it A E ;L-17 cN-e$7/- o r l,M. C A- xkko Z c1 Arab `�Is 31.9 <br /> Zfv <br /> Electrical Contractor Mail Address City State/Zip 9s-J-I .. Phone <br /> • <br /> � � �fl �3E - occ P 0 *1� <br /> State License Number(required) City of Everett Business License Number(required) <br /> 5 F #7co <br /> Proposed Use of Building Contract Price of Work <br /> �eWNls <br /> Li <br /> -1-1- 3 5 f 1i9y <br /> Square Footage(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: 7 C 1 Jt Cu It( <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 4t2-15—„ t 9, <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�� <br /> performance of construction. That I am authorized by the owner of this property to perform the <br /> work for which application is made and!comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> J7--€ ml to l s` <br /> Signature Date <br /> REVISED 08/08/2019 <br />