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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.org <br /> ��>v c.�-�-�I- , r� t�- 9 s Ze r, �j 2— <br /> PROJECT ADDRESS ew,'�e ?y�D�SSr 1n� >�✓e <br /> �F"0� �.C,►�Cc 'cf..sr�►'u'� �!lE�i cam- � <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> '130 g ,�l 5'C¢ L i /l 2 jgi6 zoo-0y4 <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> �rC� FCT, 514 ?- u 0oy <br /> State License Number(required) City of Everett Business License Number(required) <br /> I�i°0b•be <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: 1,,-,4J Oe*4r IP-'A(ACL Z&:A 1)'--c 4L cr- G'k4\ X04 <br /> t ( z ti x�i:t ccri,�� ro - t� �w l leo <br /> L4 <br /> FEE clLe i�.r�vtc� �� ir 'VL(a-) jG)PtIt�'cj r lruG� <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 �✓ <br /> I hereby certify that 1 have read and examined this application and know the same to be true and 111 <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 I am authorized by the owner of this property to perform the E I CC' <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. / / <br /> /an.a/Gvl 17 b ( G� <br /> Signature Date <br /> REVISED 08/06/2014 <br />