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Ah 0 <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 /> PROJECT ADDRESS <br /> Wdis 1'Qlc-g0 -7.502- G1Wgreen LAY Eja-d- AM 96V-02 <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> NCCt')es� ra -5f PL NE WA 4Bo?2. 'U-5-906- <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> WAWA GT- 493 P10 o q <br /> State License Number(required) City of Everett Business License Number(required) <br /> 11 goo <br /> ft I <br /> • Proposed Use of Building Contract Price of Work O��r@.rv.�edYSo�n.cArvl <br /> ®Ie- Rode 42.5.35g-oClo <br /> Square Footage (If residential new construction, remodel or addition) Contact Person/Contact Number/Email <br /> Number of devices(If low voltage) <br /> � ( J <br /> Description of Work to Be Done: <br /> Laic1�c c to►n �-o t' �y <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> t 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 <br /> performance of corrsttuction. That I am authorized by the owner of this property to perform the t 4/ij® � `7 <br /> work for whi application is made and/comply with the State Contractors Law 18.27 RCW and <br /> 296.200 <br /> • � I <br /> Signature Date <br /> REVISED 08/06/2014 <br />