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r .. <br /> 4, <br /> ELECTRICAL PERMIT&APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EUF, ETT, WA 98201 <br /> 425-257-8810 =! FAX 425-257-8857,,,-tvvv.everettwa.org <br /> o6W <br /> PROJECT ADDRESS <br /> Mall Address City State/ZIP Phone <br /> Owner ' <br /> V(c v �� � � <br /> State/Zip Phone <br /> Tenant Mall Address ,i, I City j[��— <br /> d i1„ 2-5ff-3(bG5 <br /> Cityl State/Zip Phone <br /> Electrical Contractor Mall Address !jiCF ; <br /> City of Everett Business License Number(required) <br /> State License Number(required) jr <br /> r.(2 Contract Price of Work <br /> Proposed Us of Building <br /> Square Footage if residential new construcNo., remodel or addition) <br /> Contact Per on/Contact Number/Email <br /> Number of devices (If low voltage) 1 <br /> Description of Work to Be Done: <br /> FEE '^ <br /> 00 <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> cerfi <br /> fy than!have read and examined this application and know the same to be true and <br /> 1 hereby provisions of laws and ordinances governing this type of work will be completed <br /> correct. ce <br /> whether specified herein or not. <br /> of any r gatea local law aq tlar'ng construction authority <br /> to PERMIT# <br /> violate or cancel the provision yhorized by the propertyto e-form the <br /> performance or co nsctrucctio'•made and I cotmply with the State ContractorslLaw 18.27 RCW and <br /> work for which app <br /> 296.20 WAC. <br /> _ bate <br /> Signature <br /> _ I J <br /> REVISED 06/06/2014 <br />