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ELECTRICAL RICL 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 /> Owner Mail Address City State/Zip J Phone <br /> �( <br /> k—kf O. / /69 r UJ'/ 62-0j� <br /> Tenant Mail Address City State/Zip Phone <br /> Z�J Moq P14a 90(e)- q2-06 <br /> Electrical Contractor Mail Address City State/Zip M72— <br /> Phone <br /> A)69.z) LZ P-D �� <br /> State License Number(required) City of Everett Business License Number(required) <br /> 1 <br /> Proposed Use of Building Contract Price of Work <br /> k6o,, S (W� Z 73- 7/ 7/ <br /> Square Footage (If residential new construction, remodel or addition) Contact Person/Contacf Number/Email <br /> Number of devices (If low voltage) <br /> Description of Work to Be Done: LAX n L o 4 .)2dy C,`ry J'4 <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 �.0 O <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 r O N �� <br /> performance of construction. That l am authorized by the owner of this property to perform the t !� <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> D - Zj <br /> Signature Date <br /> REVISED 06/06/2014 <br />