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• • <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.gov <br /> l0�l <br /> —2`f "" <br /> PROJECT ADDRESS <br /> b o/vn/A J 6L t rcF� /�`f 74-rr,tl wA `k za 3 Y2S 3o8=5-)L <br /> Owner Mail Address City State/Zip Phone <br /> C2A(11�1 /a5 awN,-- <br /> Tenant Mail Address City State/Zip Phone <br /> n/oAN�. rti S ,tr/�s rd12,� /L1 A <br /> N S-r I �iS-YSf-9lo� <br /> e/ <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> S "AAA eS c&--i-`SV '3lo5z- <br /> State License Number(required) City of Everett Business License Number(required) <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) �D <br /> Description of Work to Be Done: ,` �G(NG $ c c C- StAA0 <br /> �l A't l�ytic/� <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certify that 1 have read and examined this application and know the same to be true and I <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 I am authorized by the owner of this property to perform the <br /> work for which a plica bn is made and 1 comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WA <br /> Si atu a Date <br /> REVISED 08/06/2014 <br />