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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 /> 1n f w4 g7-0716. <br /> PROJECT ADDRESS <br /> Owner Mail Address City State/Zip Phone <br /> (1c°4e4 1 (171.-1" CiI2' °4,c <br /> Tenant Mail Address City State/Zip Phone <br /> 1-L W(P_ EC T c s°34 cW c641644trm,vs - C ie- 4Vf21,0 <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> bo-7, X6 3 3s7 33/A-L 'wETb ra DSS . I! 0 <br /> State License Number(required) City of Everett Business License Number(required) <br /> Propose` •e of Buildin: Contract Price of Work <br /> Square Footage(If residential new construction, remodel or addition) Contact Person/Contact Number/Email <br /> • I <br /> S-� °a(A4A/'e-1 cam--1 <br /> Number of devices (If low voltage) �.'w <br /> Description of Work to Be Done: 7 jea t/ <br /> f2y- <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 �r <br /> 4;A ` <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 El 5-1 I -04C <br /> work for which application is made and I comply with the State Contractors Law 18,27 RCW and <br /> 296.200 WAC. <br /> ?// <br /> Signature Date <br /> REVISED 08/06/2014 <br />