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ELECTRICAL IT 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 /> 3C B <br /> PROJECT ADDRESS <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> ;GG <br /> 1,3gnt e 1---J-e L 9,J>C sv✓J.l y X..., '9t�'J� 3 70 7 <br /> Electri al Contractor Mail Address City State/Zip Phone <br /> State License Number(required) CityofBusiness License Number(required) <br /> &A/e /l cvsc- js-,2 G d <br /> Proposed Use of Building Contract Price of Work <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: �� // �O C .��+. �e�N�✓� �.l / t/ <br /> c <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 �� � <br /> 1 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 construction. That 1 am authorized by the owner of this property to perform the E ' <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> e�L� <br /> Signature Date <br /> REVISED 08/06/2014 <br />