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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 /> 1401 I om'6&rA Avc.i Evy_,re:t+,WA.ggZp I <br /> PROJECT ADDRESS <br /> -Mkh"-1 1401 L0 V%A6"rdk NVE- EyQ-V-L f XU A, 9$ao l 42S 53k-: !%} <br /> Owner Mail Address City State/Zip Phone <br /> Owrv_r <br /> Tenant Mail Address City State/Zip Phone <br /> 0W Y12r <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> State License Number(required) City of Everett Business License Number(required) <br /> SCR <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 /> Description of Work to Be Done: AJA <br /> 0-4 C"&AA's n.pn a '—A&* <br /> �� aA1 'C <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> /hereby certify that/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 <br /> performance of construction. That 1 am authorized by the owner of this property to perform the E � �h I <br /> work for which application is made and/comply with the State Contractors Law 18.27 RCW and ) 4 <br /> 296.200 WAC. <br /> Signature Date <br /> REVISED 08106,2014 <br />