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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 /> RS I 0 W-c4, cites; kpo k-b <br /> PROJECT ADDRESS 1 <br /> c5C> '4 z S <br /> l)) t1 c'- CIS [ C .6/0 /I 5f0 S <br /> 6T C 1'cvC) tab c.e�19cfg?o i rzoo <br /> Owner `- Mail Address City State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> State License Number(required) City of Everett Bu 'ness License Number(required) <br /> i%f <br /> __ vts2-vo 0 1 ?�— <br /> Proposed Use of Building Contract Price of Work <br /> ' ri,1JL-N t( Z 57- 213 --q q 2 -7 <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: ( p cif ft i 1 Z /t) _ 3 ' eva'o Y 20/f C ( re( 0 0 ?S <br /> FO vt di 6 0--t-- cg_ <br /> FE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 fl 'J✓. <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 15169—l- i <br /> performance of construction. That I am authorized by the owner of this property to perform the <br /> work for which application is made and!comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> Signatui - ate <br /> REVISED 08/06/2014 <br />