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ELECTRIC L PERMIT APPLICr, TIO,, <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 /> 46 to Q.b4N/E E.:Nit-12E1—r ki )& <br /> PROJECT ADDRESS <br /> Lr©a (7e2 L (oIq 19 +4vc Ii)n 98aov <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> e <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> State License Number(required) City of Everett Business License Number(required) <br /> Proposed Use of Building 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: AL-72A-3 <br /> �c V�� r✓ <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 4 <br /> 1 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 'f construction. That I am -• Prized by the owner of this property to perform the E 115-6Z H `l q <br /> work for whic applicatio -is made a/. I co ply with the State Contractors Law 18.27 RCW and <br /> 296.200 WA a. <br /> ,4 8 /c I / J <br /> Signature v \ Date <br /> REVISED 08/06/2014 <br />