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Dec. 2. 2015 10 . 02AM Sou'lL Security Inc No. 0203 P. 1 <br /> w <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVEf�ETT, WA 98201 <br /> 425-257-8810 FAX 425-257-8857,-.wm.everettwa.org <br /> PROJECT ADDRESS <br /> Owner Mail Address Gity State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> Electrical Contractor Mail Address City Skate2lp Phone I <br /> aN -7 I <br /> State License Number(required) City of Everett Business License Number(required) <br /> Proposed Use of Building Contract Price of Work <br /> =� Qkz- - i asp <br /> Square Footage (If residential new construction, remodel or addition) Contact Per on%Contact Number/Email <br /> u i . <br /> 6 <br /> Number of devices (If low voltage) <br /> pp, ; <br /> Description of Work to Be Done: �/C <br /> e <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 � )l15,1c--- <br /> I heroby certify that 1 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 doas not presume to give authority to PERMIT# <br /> violate or cancel the provisions of any other state or local law regulating construction or the n <br /> performance of construction. That I am authorized by the owner of this property to perform the 6 1�1 <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 298-20 WAC. 4� <br /> Signature Date <br /> REVISED 08106/2016 <br />