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ELECTR�AL PERMIT APPL ATION <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 />�b�� F�� L �v� <br />PROJECT ADDRESS <br />Owner <br />Tenant <br />Electrical Contractor <br />��� r-ec <br />Mail Address <br />Mail Address <br />Mail Address <br />Cm�M�+g�7 b►� <br />State License Number (required) <br />Proposed Use of Building <br />Square Footage (If residential new construction, remodei or addition) <br />Number of devices (If low voltage) <br />Description of Work to Be Done: � n <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />� �s� ► <br />City <br />City <br />�� 1NP� q8�.ol <br />City <br />��v Z58 (088'� <br />State/Zip <br />State2ip <br />State/Zip <br />Phone <br />Phone <br />�.D �v �o �p <br />Phone <br />OI(o04� <br />City of Everett Business License Number (required) <br />25� r <br />Contract Price of Work <br />` �25z5g�s5d <br />Co act Person/Contact Number/Email <br />! hereby certify that ! 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 worfc will be completed <br />whether specified herein or not. The granting of a pennit does not presume to give authority to <br />violate or cancel the provisions of any ofherstate orlocal law regufating construcfion orthe <br />performance of consfruction. -That 1 am authorized by the owner of this property to perform the <br />work for which applicafion is made and 1 comply with the State Contractors Law 18.27 RCW and <br />296.200 WAC. <br />Signature <br />REVISED 08/062014 <br />Date <br />/ <br />FEE <br />��°� <br />PERMIT# <br />E ����� � � � <br />