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01!24/2015 21 : 19 4*,6178 P. 001/001 <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�I 06 �1 e IIA-AJ J=.�WE <br /> PROJECT ADDRESS <br /> Owner Mail Address City statelzip Phone <br /> /If 6 CW'LfC&j — <br /> Tenant Mail Address city statwzp Phone <br /> �Zf <br /> lU A ,Z(a ZY 2,1 <br /> Electrical Contractor Mail Address City 5tate/7_ip Phone <br /> 6/"/V,CC / y 21.4/) Q 16-7`. ?- <br /> State I_ioensa N�u/Jmiter(required) City of Everett Busine s License Number(required) <br /> Propos®tl 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) �1 <br /> Description of Work to Be Done: <br /> I <br /> l i�� .•2 j,� t v <br /> FEE <br /> CITY OP EVERETT LOCAL SALES TAX CODE IS 3105 �G7 �— <br /> /hereby certify that l 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 specked 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 Is p i -'z <br /> work for whicq 9pplica6an is made and J comply with the State Contractors Law 18.27 RCW and <br /> 296.200 W <br /> Signature Date <br /> ' REVISED 08R1G2076 <br />