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11/23/2015 03 :07 #7571 P. 001/001 <br /> 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 /> IS 2 <br /> PROJECT ADDRESS Yz 357 <br /> ct ' 3 s )A .c i 2.0 l f, <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mall Address City State/Zip Phone <br /> EKAA Mt— S�S Pc lyty 7foc, y s idy 1/&./ <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> • <br /> State License Number(required) City of Everett Business License Number(required) <br /> �7 /fdend <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 /> • <br /> Number of devices(If low voltage) r, }� �j � j ILL <br /> Description of Work to Be Done: / t ii b _A A .A L I Ji <br /> FEE e <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 7 / l <br /> /hereby certify that I have read and examined this application and know the same to be true and v _ <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 PERM!T# <br /> violate or cancel the provisions of any other state or local law regulating construction or the <br /> performance of construction. That I am autho»zed by the owner of this property to perform the E 15 J f ( 3 <br /> `� <br /> work for which a•'lication is made and I comply with the State Contractors Law 18.27 RCW and l <br /> 296.200 WAC/ <br /> • <br /> • // ' 3 <br /> fgnature sate <br /> R; SEDOWOB4O14 <br />