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ELECTRICAL PERMIT APPLICATI�ON <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 />F <br />PROJECT ADDRESS <br />Owner <br />Tenant <br />Mail Address <br />Mail Address <br />C ity <br />City <br />State/Zip <br />State/Zip <br />Phone <br />Phone <br />,�r� rn Q/�- <br />EleCtrical Contractor Mail Address City State/Zip Phone <br />State License Number (required) <br />�' ra 0� �/ <br />Proposed U e of Building <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />Description of Work to Be Done: <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />City of Everett Business License Number (required) <br />Contract Price of Work <br />Contact Person/Contact Number/Email <br />1 hereby certify fhat I have read and examined this application and know the same to be true and <br />correct. All provisions of laws and ordinances goveming 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 <br />violate or cancel fhe provisions of any ofher state or /ocal law regulating construction or the <br />performance of construction. That 1 am authorized by the owner of this property to perform the <br />work for which application is made and 1 comply with the State Contractors Law 18.27 RCW and <br />296. 200 WA C. <br />REVISED 08/O6/2014 <br />FEE <br />� jd ����' <br />PERMIT�1� <br />E �� l� -��� <br />