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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, VVA 98201 <br />425-257.8b10 - FAX 425-257-8857 — www everettwa org <br />PROJECT ADDRESS <br />VoAlfwi <br />Owner I Mail Address City Stale/Zip Phone <br />Tenant Mail Address City stale'71p Phonu <br />4� LtrY S5Ak <br />u 1, , N. � � v � '-���V� ill" St CYlu�1C\Yll ��'} t�A}�l • �I�r?-�1�r <br />Electrical Contractor Mad Address Clty State/Zip Phone <br />Stale License Number Contract Price of Work <br />Proposed Use of Building Contact Person (Plan Review) <br />Square Footage (If residential new Construction. remodel or addition) <br />Number of devices (II low voltage) <br />Description of Work to Be Done: <br />FEE rl� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 �O `�^�' <br />I homby certify that I have read and examined (his application and know the some to be firm and <br />compel 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 pmsurne to give mrthadty to PERMIT# <br />violate or cancel the provisions of any other state or local low regulating construction or the I <br />performance of construction. That I am authorized by the owner of this properly to perform the <br />work for which application is made and 1 comply with the State Contractors Law 18.27 RCW and <br />296 200 WAC. <br />ignalum Date <br />RENSEa 19a9e __ <br />