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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 /> -aj ) i 1 $ Ths1 - <br /> PROJECT ADDRESS <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> Dd. k E p, o, 80X Z_.1 / 7 Lyiw 9.P03_J y"2 7CS� <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> • <br /> State License Number(required) City of Everett Business License Number(required) <br /> lZ tf s Z" t,T)L-c-E 0, 3 .70, <br /> Proposed Use of Building Contract Price of Work <br /> /J X Cox <br /> 1, 6 c7z zoC- 715_ ) /G <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: ( -L—Lae YJ L(L T <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I 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 E1142-1(66 <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and _ <br /> 296.200 WAC. <br /> Signature Date <br /> REVISED 08/06/2014 <br />