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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 /> 'A 31 c�uhz-*-V� Avg,. <br /> PROJECT ADDRESS <br /> ..Jorlb�en iZD <br /> \4A q <br /> Owner Mail Address J City State/Zip Phone <br /> Tenant Mail Address city State/Zip Phone <br /> Inc qYV5 lNetft5E-� Lav-121 <br /> t+IY06 Y" (413 LP <br /> Electrical Contractor Mail Address City State/Zip Phone' <br /> RL�5P-,T -* )I D62 ()26 l45 <br /> State License Number(reuired) —City of Everett Business License Number(required) <br /> �5 CYL— C& <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: <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 7j ,DO <br /> 1 hereby certify that I have read and examined this application and know the same to be true and <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 <br /> work for which application is made and/comply with the State Contractors Law 18.27 RCIN and <br /> 296.200 WAC. <br /> Signature Date <br /> REVISED 08106)2014 <br />