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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 /> LOG- U(OSO 6AIL SE — <br /> PROJECT ADDRESS <br /> Owner Mail Address City State/Zip Phone <br /> WOOD&KODk � No <br /> Tenant MailAddress City State/Zip Phone <br /> O3 Ac c.,NL 22-` - I w' eL Leat- 4203 tlzs 70 .686c) <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> State License Number(required) City of Everett Business License Number(required) <br /> 0i P <br /> Proposed Use of Building Contract Price of Work <br /> Square Footage(If residential new construction, remodel or addition) Contact Person/Contact Number/Email <br /> Number of devices (If low voltage) <br /> k ( ),.,, ` <br /> Description of Work to Be Done: �'.x \ <br /> (r. OL ,r v\ 1� t �`�t�� ,44s)rfil <br /> —FOP ftN,ct ,,, e cL .b1 -c r t- - <br /> T- <br /> N-e k_ rqevre <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 41) <br /> £q „ 5-0 <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 16'069-069'l <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 I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> /TJ,„4 23/ r <br /> 111 " ignatur- — Date <br /> REVIS-•08/06/2' 4 <br />