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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 /> / 702 - C <br /> PROJECT ADDRESS <br /> C✓1 v C 1 K— xi'7 c 7 - (6 r 14-- (J�'-f'°- f /f •`3 ✓� 4 'eZ? •06 0 <br /> Owner Mail Address V City State/Zip Phone <br /> Co Ie )-a(ltk Earno mnc <br /> Tenant Mail Address City State/Zip Phone <br /> OtAi/k. / <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> • <br /> State License Number(required) City of Everett Business License Number(required) <br /> 30 ? <br /> Proposed Use of Building Contract Price of Work <br /> H <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: <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 �{ <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 0 <br /> performance of construction. That I am authorized by the owner of this property to perform the E 14 I - O �q <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WA C. <br /> / / r / <br /> Signature Date <br /> REVISED 08/06/2014 <br />