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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 /> 6® ( MA oL shy <br /> PROJECT ADDRESS <br /> Ah rA 1-FA hit S o� �d 25 = 5 <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> C <br /> 14�e2 --�7�u'kc r~ �E.�`f i'�'vA r P06 Pk o n'd LAM- <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> L t "t5 -r`f�f'--tA a <br /> State License Number(required) City of Everett Business License Number(required) <br /> Proposed Use of Building Contract Price of Work <br /> Square Footage(If residential new construction, remodel or addition) Contact Person/Contact Number/Email <br /> Number of devices (If low voltage) <br /> Description of Work to Be Done: <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 060,019 <br /> /hereby certify that l 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 <br /> performance of construction. That l 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 /> ( <br /> Signature Date <br /> REVISED 08/0612014 <br />