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ELECTRICAL PERMIT APPCiCATION <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 />lJ ID E �eec �n Lva �i tj 9�203 <br />PROJECT ADDRESS <br />t Zl� <br />Owner <br />Mail Address City State/Zip Phone <br />LI3o-zy(9 <br />Tenant Mad Address City State/ZDp Phone <br />—(-)h?V1e-v' SlatelLp Phone <br />Cat <br />Electrical Contractor Mail Address Y <br />State License Number (required) City or Everett Business License Number (required) <br />Proposed Use of Building Con race Price of Work <br />Square Footage (If residential new construction, remodel or addilion) <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 />N�a s P r oZ rilaa l �i �Y <br />Contact rsonlCo l cl Number/Email <br />1 hereby certify that I have mad 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 other state or local law regulating construction or the <br />performance of construction. That 1 am authorized by the owner of this property to perform the <br />work for which application is made and I comply with the State Contractors Law 16.27 RCW and <br />296.200 WAC. <br />ifS <br />ignature / Date <br />FEE <br />-750� <br />PERMIT# <br />REVISEDe0i 0014 <br />