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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 /> 10 `a v 2 5 k r-e jget / 10 <br /> PROJECT ADDRESS <br /> Owner Mail Address City State/Zip Phone <br /> 6-11 1 r P 11.-e.kLAA S-Y ive <br /> Tenant Mail Address City State/Zip Phone <br /> m i'\n c CV C 1 ?-7"- -v- i,,,J , & (►A- 9X001 . 5-71 z 6c. <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> err Al C— � .7C � (e y oc � � s5 <br /> St to License Number(required) City of Everett Bu iness License Number(required) <br /> / \ c O <br /> Proposed Use of Building Contract Price of Work <br /> cc ' , C-7( 7q(09 <br /> Square Foo ge(If residential new construction, remodel or addition) ntact erson/Contact umber/Email <br /> Number of3vices (If low voltage) <br /> Description of Work to Be Done: r) f�,,Q pfd �r _ M0\V SST <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 /' 0 Dy <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 r ` <br /> performance of construction. That I am authorized by the owner of this property to perform the t l <br /> 0 if- 1 tact <br /> work for which application is made and I :- •ly with the State Contractors Law 18.27 RCW and <br /> X246.29% ' . <br /> ----7Signature Date <br /> REVISED 08/06/2014 <br />