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ELECT ICAL 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 />L <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 Business License Number (required) <br />_ Le ) NAEt- l-1 'T! & U <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: 3 ��Oc) 6 0-)- i- o©-T- <br />FEE <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 120 <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 I ���^ <br />performance of construction. That I am authorized biy the owner of this property to perform the <br />work for which app ' ation is made and I comply with the State Contractors Law 18.27 RCW and <br />296.200 WAC. <br />l '6"" ---- <br />C;�'Zah'-� <br />Signatur Date <br />REVISED 0810612014 <br />