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Oct 02 15 05:18a Oregon Protective Service 503-759-4800 p.1 <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 /> — q92-0S <br /> PROJECT ADDRE S <br /> Wim& Fox"J ,TrLn( �t I rv�ri� ����0 4 ,��c. ss� <br /> Owner MaA Address <br /> C+tY State/Zip' Phone <br /> n� CM.,l <br /> �4,nr.� �orCce. ��r► 1 �+ A+��a'tC �C' - -2",LZ -7Sl <br /> Tenant Address Ci State/Zip Phone <br /> Qco��n?�c -4th (cesf �OG3�x M .o f'' LA.�',_!L\O C _ Dbq-4- 9-71-2-4f, <br /> Elect al Contractor Mail Address City State/Zip Phone <br /> State License Number(required) City of Everett husiness License Number(required) <br /> Aj <br /> Proposed Use of Buildi,.� Contract Price of Work <br /> Square Footage(if residential new construction, remodel or addition) Contact Personp/Contact,;Number/Email <br /> Number of devices(If low voltage) V CJ <br /> Description of Work to Be Done: z <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 � i� D <br /> l hereby certify that I 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 /> Performa of construction. That I am authorized by the owner of this property to perform the <br /> wor or which plication is made and I comply with the State Contractors Law 18.27 RCW and <br /> 20A.200 WA C. <br /> a re Date ' <br /> REVISED 08/0WW14 <br />