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�L������d'�A� ������ �����������Y <br />�I`�1( OF EVERET`� PER�VII`� ��R�/ICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />�`. <br />PROJECT ADDRESS <br />Owner <br />Tenant <br />Electrical Contractor <br />State License Number (required) <br />Proposed Use of Building <br />,; <br />;, <br />Mail Address <br />Mail Address <br />Mail Address <br />City <br />City <br />City <br />,� � '! 4 . , - <br />State/Zip <br />State/Zip <br />State/Zip <br />Phone <br />Phone <br />Phone <br />City of Everett Business License Number (required) <br />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: � f' <br />FEE <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 ��� D� <br />� � <br />I hereby certify thaf l 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 />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 stafe or loca! law regulating construction or the r � <br />performance of construction. That I am authonzed by the owner of this property to perform fhe t�� � l D � <br />work for which application is made and 1 comply with the State Contractors Law 18.27 RCW and <br />296.200 WAC. <br />i� "- � � ��� � ' - � <br />, __ <br />� � - __-���-` _ .� = �� ` � _ <br />T iqnature � ate <br />REVISED 08/06/2014 <br />