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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 /> PROJECT ADDRESS <br /> BccA -5 3t z g� ALE J ti-,su• 1k2 c�g2-� 42S-2(1°Z? <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> C>LA-) E <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> vs3cfG <br /> State License Number(required) City of Everett Business License Number(required) <br /> "—Tt" Vti\V <br /> Proposed Use of Building Contract Price of Work <br /> 1 yZs- <br /> ago 2 y a9 <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: ke VY'\ e 1-e <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 "JD <br /> m <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 I y ` r <br /> performance of construction. That I am authorized by the owner of this property to perform the E 1.) (I ° <br /> work for which application is m.de and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 W C. <br /> Co - 23- 2cic <br /> Signature Date <br /> REVISED 08/064014 <br />