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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 /> Z C 01by nom <br /> PROJECT ADDRESS <br /> Z0Lo <br /> [vAr\5 IAA52,Twnt2.1 Colby Avi= 1^vercwA 162.0 330 - 1 <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> 0 vi e <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> • <br /> State License Number(required) City of Everett Business License Number(required) <br /> Proposed Use of Building Contract Price of Work <br /> (L1 <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: n 2.1 e G\-r`cq\ 6 a ne U' w v C`t r, <br /> 3C;,ru6'Z. nev.) CPer-on C 3 `JO& " OZ7 ) <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 "') t; d <br /> /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 EO7 r / 7 <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> — 23 <br /> Signature Date <br /> REVISED 08/06/2014 <br />