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05/25/2015 20:25 #6775 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 /> • <br /> PROJECT ADDRESS <br /> P4, afr . /7,140 0 .o A4 4* A 1i �. i <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address City State/Zip y2thone <br /> 'L ipr1 Pd gon / a/ A , State/Zip�� )S91h2/ <br /> Electrical Contractor Mail Address City <br /> one <br /> Fi/LkiiSrI Y2 Li_ 01436 <br /> State License Number(required) City of E Brett Business License Number(required) <br /> 'Sa <br /> re o-''-'r Goin cv-ltrS' - - <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: Je / Iff%' . <br /> C / C . 0 <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 . 1 `r V <br /> d1 <br /> l 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 Q <br /> performance of construction. That lam authorized by the owner of this property to perform the E ft- o- i u <br /> work for which ap,ication is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> - 11/ _______ ,2 4/4r <br /> ature Date <br /> REVISED 08/052014 <br />