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• <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 9`ag <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org ---Dg <br /> O g_D07 <br /> 5( 3O CONMF,RCIAV& SveR_ETT, wA <br /> PROJECT ADDRESS <br /> INES T.3ANDKA 5630 OrtrteRCitiL A(tE EvEkETT WA 98.243 (266)261-65?6 <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> uwNEIZ <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> State License Number(required) City of Everett Business License Number(required) <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: E.LECTP C,I L W021L FURNACE AND Gu4TT2 <br /> FEE <br /> 06 <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 �O ' <br /> I 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 r <br /> performance of construction. That I am authorized by the owner of this property to perform the E U I f co 7 <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> Z /./3 /111 <br /> Signature I Date <br /> REVISED 08/06/2014 <br />