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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 /> Fw <br /> PROJECT ADDRESS <br /> L) cc L 2 u:e ve % e 3iU e v; i(lG ', U,3 <br /> Owner Mail Address City State/Zip Phone <br /> /� '2w <br /> C l St Si%l_slc i �e �U C-yr're.(f wh -/I�' <br /> Tenant Mail Address City State/Zip Phone <br /> Electrical Coritractor Mail Address City State/Zip Phone <br /> State License Number(required) City of Everett Business License Number(required) <br /> Proposed Use of Building Contract Price of Work <br /> CellAel <br /> Square Footage(If residential new construction, remodel or addition) Contact Person/Contact Number/Email <br /> Number of devices(If low voltage) J <br /> Description of Work to Be Done: hi 5fiul l (2S/4 q�Q.0 3 p65e- e rt-v; ecy me4c�1 <br /> El(he11 E?X1`S"1 i no,:� I-5 V 3 0 vie.y locctfry)q TMJ 1leu-j <br /> _ li,«-in eov Prne� �. <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 ?j <br /> I 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 O <br /> performance of construction. That/am authorized by the owner of this property to perform the <br /> work for which application is made and/comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> J � 5 <br /> Signature Da <br /> REVISED 08/0612014 <br />