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MY OF EVERETT PERNTI SERMEMS <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />LA '5�Wea <br />PROJECT ADDRESS <br />Owner Mail Address City State/Zip Phone <br />Tenant Mail Address City State/Zip Phone <br />e4V t(P "LCA kid <br />Electrical Contractor Mail Address City State/Zip Phone <br />2- 0(2- <br />St e License Number (required) City of Everett Business License Number (required) <br />°Lb[UU, L�1J <br />Proposed Use of Building Contrue�act Price/ Work <br />1'5vtO 16re A V <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: qA l y- <br />FEE <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />l hereby certify that l 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 orlocal 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 l comply with the State Contractors Law 18.27 RCW and <br />296.200 WA <br />Signature Date <br />REVISED 0810612014 <br />78 <br />