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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.gov <br /> \ o `���s �� S� J , EVILS-Q <br /> PROJECT ADDRESS <br /> S n') C-0 �I aa O 0 CcIL C\ <br /> Owner Mail Address City State/Zip Phone <br /> Lac S3 c c <br /> Tenant Mail Address (� City State/Zip Phone <br /> IfnQJ VQ ESQ c iC�`Y1L ? c bcx (---t&c) ) E wo-o3d <br /> Electrical Contractor Mail Address City StatLe./�ZipJ P he3 <br /> isD <br /> State License Number(required) City of Everett Business License Number(required) <br /> LD .f1-) <br /> Proposed Use of Building Contract Price of Work <br /> 1 Cw r. r) Pc t \r� <br /> la <br /> Square Footage(If residential new construction, remodel or addition) Contact Persor�LQontact Number/Email <br /> m1 <br /> Number of devices (If low voltage) <br /> Description of Work to Be Done: IEC rri c. '�£�r �—.S p4+ `OLS <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certify that I have read and examined this application and know the same to be true and aIDt' <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 E i S V W <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> .200 WAC. <br /> cow . — C9�1�,15 <br /> Signature Date <br /> REVISED 08/06/2014 <br />