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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 /> PROJECT ADDRESS <br /> � � � •_ , <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> � �� � - � - ' � ,.., � � � : <br /> � .'�;�, i �ti_�,i.`� <br /> Electrical ContraCtor Mail Address City State/Zip Phone <br /> ���� •��. __ �,, ,� ,i' ." . - <br /> State License Number(required) City of Everett Business License Number(required) <br /> Proposed Use of Building Contract Price of Work <br /> .i , _ , � <br /> Square Footage (If residential new construction, remodel or addition) Contact Person/Contact Number/Email <br /> Number of devices (If low voltage) <br /> � ��i � , ��y � - �, . . <br /> Description of Work to Be Done: , �' �� `- ' <br /> ' 'I � `. ' � jv :_. ' � <br /> ., <br /> ; � , - . : - • <br /> ,` , , <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 ,(� I �1�)\� <br /> `tl � VU -� <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 goveming this type of work will be completed <br /> whefher 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/ocal law regulating construction or the � � ���� ���� <br /> performance of construction. That I am authorized by the owner of this property to perform the <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> � � ! <br /> s <br /> " S nature � Date <br /> y — <br /> � <br /> REVI SED 08/06/2014 <br />