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r 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 /> 125?D5 2 T S1- Ou'Z SE, <br /> PROJECT ADDRESS <br /> L 1255,o� 21 s+ &e E4azfWA g9_202 <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address Ci State/Zip Phone <br /> f�yy _ "� (` n_ q92:70 <br /> Electrical Contractor Mail— City State/Zip Phone <br /> CK_4�6 t_tL 8(034ZA b�;�3058 <br /> State License Number(required) City of Everett Business License Number(required) <br /> Proposed Use of Building Contract Price of Work <br /> J"V�_ � T� -3W.�Ag_ <br /> Square Footage (If 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: <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> /hereby certify that/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 ^n I O� D�^ <br /> performance of construction. That/am authorized by the owner of this property to perform the t 6 It <br /> woAk for which appliation is made and/comply with the State Contractors Law 18.27 RCW and <br /> 296 20 <br /> � j <br /> Signature Dalte <br /> REVISED 08/0612014 <br />