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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 425257-8857 www.everettwa.org <br /> 10,9 6 w A -(t--. v,,t,r t-Or q BD o l <br /> PROJECT ADDRESS <br /> 4- L. <br /> Owner Mail Address <br /> City State/Zip Phone <br /> Tenant Mall Address <br /> 1 . 1 ,� City State/Zip Phone <br /> r l4yt -l.r\ 1 0) `�-1 ^ L •L . q 108 D <br /> Electrical Contractor Mail Address <br /> City State/Zip Phone <br /> ("y .ct ke.a oa a9 3 0 <br /> State License Number(required) City of Everett business License Number(required) <br /> 300 <br /> Proposed Use of Building Contract Price of Work <br /> -C , B. 1400 <br /> Square Footage(if residential new construction, remodel or addition) ontact Person/Contact Number/Email <br /> Number of devices(If low voltage) <br /> Description of Work to Be Done: d t_-a..- t— / �� I 1 a- - <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 15, De <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 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 or local law regulating construction or the <br /> performance of construction, That I am authorized by the owner of this property to perform the E (a00 <br /> work for which application is made and)comply with the State Contractors Law 18.27 RCWand v0 <br /> v <br /> ' 90.200 WAC. <br /> —�� _ ) <br /> Signature "' Date <br /> REVISED 08/064 014 <br />