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Oct, 5. 2015 11 : 32AM No. 0868 P. 1 <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 /> PROJECT ADDRESS <br /> eA&x4,' � <br /> Owner Mall Address City state/Zip Phone <br /> t� "0-8/ 6* 'A <br /> Tenant Mail Address City State/Zip Phone <br /> le foal Contra Mail Addres City State/Zip <br /> We license Number(required) City of Everett Business License Number(required) <br /> deW&PA .1OAS <br /> Proposed Use of Building Contract Price of Work <br /> 4 12,1�� &47/ <br /> Square Footage('f r6sidential new construction,remodel or addition) Contact Pere Q /Co berlEmail <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 � �10 i 9 <br /> Ihereby 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 <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 I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> /0-/ -/�' <br /> Signature Date <br /> REVISM O&OM016 <br />