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10/19/2015 10:31 FAX 425 257 8857 EVERETT PERMIT SERVICES @003/003 <br /> 9 W — <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 /> It� 2Z C-�r0, d A . <br /> PROJECT ADDRESS <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> ar V t��,n Qf\ �-zr-prksr S6� � l ,x 1 �Z I(Y�<�cuS j� 1.�j 9 h�3-`�`f3s <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> C-sA V,VS ��qC'i I UY 039 f o _�- <br /> State License Number(required) City of Everett Business License Number(required) <br /> t` <br /> Proposed Use of Building Contract Price of Work <br /> Square Footage(1f residential new construction, remodel or addition) Contact Person/Contact Number/Email <br /> Number of devices(if low voltage) <br /> Description of Work to Be Done: I g''O-�t r\0) Q Cd vt-S <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 ' D O 06 <br /> t hereby certify that J have read and examined this application and know the same to be true and <br /> correct. All provisions of laws and ordinances goveming 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 orlocal law regulating construction or the I f 1/^D�, <br /> performance of construction. That l am authorized by the owner of this property to perform the 1 <br /> work for which application is made and t comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> Signature Date <br /> REVISED OPrEM&2014 <br />