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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 />2 � � � ��---� ,� �� � �,� �iv� ��r��--� W�� <br />PROJECT ADDRESS <br />� C-� �� r� � �� � � <br />Owner <br />Tenant <br />� � � ��s �� <br />Electrical Contractor <br />State License Number (required) <br />���I �X <br />Proposed Use o Building <br />Mail Address <br />Mail Address <br />Mail Address <br />C`(��� (� ��,/ <br />City <br />W, ���� <br />Sq �re Footage (If residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />Description of Work to Be Done: <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />�,�/, <br />iv C <br />City <br />City <br />., <br />C ���> �� <br />State/Zip <br />State/Zip <br />State/Zip <br />l`'ll�� <br />Phone <br />Phone <br />Phone <br />������ <br />City of Everett Business License Number (required) <br />Contract Price of Work <br />Contact Person/Contact Number/Emaii <br />1 hereby certify fhat 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 <br />violate or cancel the provisions of any ofher state or local law regulating construction or the <br />performance of construction. That 1 am authorized by fhe owner of this property to perform the <br />work for vuhich application is made and I comply with the Stafe Contractors Law 18.27 RCW and <br />296.200 AC. <br />�,� % /�. � `� � ` � �/ <br />� <br />Sianature � Date <br />REVISED 08/O6/2014 <br />FEE <br />�� 0�' <br />PERMIT# <br />E��c��-i-�� <br />