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NOW <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.gov <br /> 9,OM 04-017T A V6 -51)17-e .2a0 <br /> PROJECT ADDRESS <br /> CUE ?T PLAY-16 F76611.777E5 450641T 11V4 99.24/ �la1S�-3��-248'6 <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> bU-) A)6- 2 <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> State License Number(required) City of Everett Business License Number(required) <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: RELOCATE 6X RA) DUTLG-TS Su ,PGy Z <br /> 16 IN 120 V61-7- C/R('u l S TD A S PA C E —A h1 iV5YDW - '4ID <br /> FIfZG f}LARM SYS3z-M 96)2A)- .!57-R636- <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 �D C)G <br /> o � <br /> /hereby certify that/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 <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> ; � 6 bz 1,2 <br /> Signature Date <br /> REVISED 08/06/2014 <br />