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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.gov <br /> SIO ,4— A v.f <br /> PROJECT ADDRESS <br /> Owner_ Mail Address City State/Zip Phone <br /> �cI/1a_c-k r+ <br /> Tenant Mail Address City State/Zip Phone <br /> S Co CCA-6( , /14Z_ e_ Sys izo1 EUP. r cc.,v4 FS.20c 2 SZsr <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> caG,T91NDO D � 5 <br /> State License Number(required) City of Everett Business License Number(required) <br /> so— <br /> ./DWI wt ,-H 3,-00 <br /> Proposed Use of Building Contract Price of Work <br /> 660 <br /> Square Footage(If residential new construction, remodel or addition) Contact Person/Contact Number/Email <br /> Number of devices(If low voltage) <br /> -� <br /> Description of Work to Be Done: �v`'S1'vt- 11 (/'QiC-C Da �G76/i h Sf-/l <br /> FEE <br /> ts <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 0 6 <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 E - (3 .1performance of construction. That I am authorized by the owner of this property to perform the U <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> /ms' s - /d— 20 — / S- <br /> Signature Date <br /> REVISED 08/06/2014 <br />