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Dec. 10, 2015 8 : 57AM So nd Security Inc ------*-No. 0204---P, 1 <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVgff-TT, WA 98201 <br /> 425-257-BB10 FAX 425-257-8`857,,www,everettwa.org <br /> PROJECT ADDRESS <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address City StatelZip Phone <br /> I ► d ' 1�, p, IC. �r�a2 ( &Lrn., ��l e �A)*2�" d I Z 5 X—�(p� <br /> Electrical Contractor Mail Address City Stale/Zip Phone <br /> a/� ` F QILO)b--7 131 q� <br /> State License Number(required) City of Everett Business License Number(required) <br /> r L( <br /> Proposed Use of Building ! Contract Price of Work <br /> Square Footage(if residential new const bn, remo el or addition) Contact Per on/Contact NumberlEmail <br /> Number of devicds (If low voltage) <br /> Description of Work to Be pone: <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 ( tij <br /> I hereby certify that I have read and examined this application and know the same to be true and ` v <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 presurne to give authority to PERMIT# <br /> violate or cancel the provisions of any other state or local law regulating construction or the �� �._O <br /> performance of construction. That I am authorized by the owner.of this property to perform the <br /> 17 <br /> work for which application Is made and I comply with the State Contractors Law 98.27 RCW and <br /> 296.20 WAC. <br /> jar, Z� D �� �— <br /> - Signature .t)�te <br /> REVISED OWU6/2014 <br />