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Nov, 4. 2015 1 : 37PM No. 0761 P. <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-2578810 FAX 425-257-8857—www,everettwa.org <br /> i; <br /> PROJECT ADDRESS <br /> Owner Mall Addross City St9te'%zi,p, Phone <br /> 2 <br /> tk(,(,;,A 0 S ,,) <br /> S ( f --f <br /> Tonont Mall Address city State/7ip Electrical Contractor Mall Address City ''tat-e/7ip Phone <br /> State License Number(required) City of Everett Business License Number(required) <br /> FIL DID <br /> Proposed Use Of Building Contract Price of Work <br /> SqUT -Dotage(if residential new construction,remodel or addition) Contact erson/Contact Number/Email <br /> F <br /> 'Number of dovices;(if low voltage) <br /> Description of Work to Be Done: 01 <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE 18 3105C)o <br /> I hembly certify that I have read and examined this application and know Ma same to be fille and 6-b ....... <br /> correct All provisions ofiiwsand orclin,7nro.,;governing this type of work will be completed <br /> wi7cther.,qpL-cifiedherein orrioL The granting of a permit does not presume to give authority to PERMIT# <br /> violate or Cancel the provisions of any othor stato or local law regulating construction or the <br /> parfonl7anroofconstruction. That I am authorized by the owner of this property to perform the E <br /> work ror Which a1pplication is made and/comply with the State Contractors Law 18.2%RCW and <br /> 2.96,200 WAQ/ <br /> .......... — <br /> / <br /> Signature Date <br />