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LO), dC <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 /> 1 f � <br /> en Sl 1 �� L..lw <br /> PROJECT ADDRESS <br /> c � c. " Ja<.' 4 s � <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 /> r x !,� DC2( 114 <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 /> C..I <br /> Number of devices(If low voltage) <br /> Description of Work to Be Done: ,, % L , <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certify that I have read and examined this application and know the same to be true and �J <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/am authorized by the owner of this property to perform the <br /> work for whiCl� pplication is made and l comply with the State Contractors Law 18.27 RCW and <br /> 296.200 W <br /> Signature Date <br /> REVISED 0WO&2014 <br />