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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.gov <br /> 4 Ski 1 b1 vim. - 9 Ca a© <br /> PROJECT ADDRESS <br /> '7k /to 3•�o� 5 tl i_n .e.1)e ‘/%e r4 I >,tM RC?to' ar c <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> Ptha b �r 'C©n rikt.A-i,>�r,, -� a09 va149 �A, toA g14- <br /> Electrical Contractor Mail Address City State Phone <br /> State License Number(required) City of Everett Business License Number(required) <br /> pp �� r <br /> O�M.`YI GO rl LG(7 (4/h c;frIc G 7 <br /> Proposed Use of Building Contract P ce of Work <br /> 11 Lk, <br /> Square Footage(If residential new construction, remodel or addition) Contact Person/Contact Number/Email <br /> Number of devices(If low voltage) ]],,_Description of Work to Be Done: '}'�� it- -1 et!.L�� 96\ <br /> 1 af bp <br /> FEE ,,ee���� <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 31054 <br /> Gy�� w <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 r i `0�� <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!comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> 14/8,4 <br /> Signature Date <br /> REVISED 08,0612014 <br />