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NEW <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.org <br /> 2,113 .- L Titin n UE <br /> PROJECT ADDRESS <br /> Sq wi c e c'snArvo AVzC�«z ,—; �✓ -� �=� yd 5-1175!J c 2Y <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> v'V E2L�kc �cCc %t p o. . `!C44'y /3tI LLtZ ✓,��- �� 15 773-V--?�I <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> State License Number(required) City of Everett Business License Number(required) <br /> K? <br /> 1 S so 44, <br /> Proposed Use of Building Contract Price of Work <br /> =WlX 7"13 C�C�bel <br /> Square Footage (If residential new construction, remodel or addition) Contact Person/Contact Number/ mail <br /> Number of devices (If low voltage) <br /> Description of Work to Be Done: AL)tj (:4 2,-&(,'7 rU`Z �� �� �•�/�%r /3/UCT� <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 ®� d01-1 <br /> /hereby certify that/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 r <br /> performance of construction. That/am authorized by the owner of this property to perform the <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> Signature Date <br /> REVISED 08/06/2014 <br />