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From: 0 09/2015 08:30 #111 P.001 /002 <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201L <br /> 425-257-8810 - FAX 425-257-8857-www.everettwa.gov"Ot Ta <br /> PROJECT ADDRESS <br /> Owner /� Mail Address City State/Zip Phone <br /> WA <br /> Tenant Mail Address City State/Zip Phone <br /> �,%f�����i'� �6 �d� load l•�i�raitl f� <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> State License Number(required) City of Everett Business License Number(required) <br /> � EG v��S�D• dd <br /> Proposed Use of Building Contract Price of <br /> Work <br /> Square Footage(If residential new construction, remodel or addition) Contact Pe on/Cont ct Nu b <br /> Number of devices(If low voltage) <br /> r <br /> Description of Work/to Be Done: <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 �' <br /> l hereby certify that I have read and examined this application and know the same to be true and 1 -7 <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# a(� <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 D _. <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and ` <br /> 296.200 WAC. <br /> Signatu Date <br /> REVISED 08/062014 <br />