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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERET T, OVA 98201 <br />425-257-8810 - FAX 425-257-8857 — vrrnry everettwa org <br />PROJECT ADDRESS <br />Owner rdad Address City Slate/Zip Phone <br />Tenant MailAddress City State/Zip Phone <br />r � <br />Electrical Contractor Mail Address City StatelZip Phone <br />Slate License Number <br />1!5� ouz-! ✓S e / G <br />Proposed Use of Building <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (11 low voltage) <br />Description of Work to Be Done: <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br />. s // old <br />I OW <br />Contract Price of Work <br />Contact Person (Plan Review) <br />I hereby certify that 1 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 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 <br />work for which application is made and 1 comply with the State Contractors Law 18.27 RCW and <br />296.200 WAC. ,.,, <br />o--112 <br />Gl1LQA u i <br />FEE <br />PERMFT# <br />E14 06 -11 <br />