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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 2 3 <br /> / oq <br /> PROJECT ADDRESS <br /> /e)// &vAi K Ai /go? /�,gJLe / ve cYe, e7 44,4 <br /> Owner Mail Address tity State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> 6A'v''ze,LeG% 'c/lam 9957 S-w0,k/Z2�.,o 6,447 982>.s-" <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> • <br /> Ga 5 c • #05 3307 <br /> State License Number(required) City of Everett Business License Number(required) <br /> 41 <br /> 7090 <br /> Proposed Use of Building Contract Price of Work <br /> 20 s-- <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: RCe,L4J//2J. LAS /���� .I //may /2 <br /> L %S " /ADD Si oA& /Jeie,ci 0/2,5 AJJ/eAe,� d <br /> FEE tilt <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 - ` <br /> I hereby certify that 1 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 I am authorized by the owner of this property to perform the E <br /> work for which application is made and 1 comply with the State Contractors Law 18.27 RCW and V <br /> 296.200 WAC. <br /> Z 3—/5 <br /> - <br /> Signature Date <br /> REVISED 08/06/2014 <br />