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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 /> cyg <br /> PROJECT AbDRESS <br /> q a <br /> _ iY1 �1rQvS • Q <br /> Owner Mail Address f ``� <br /> City State/Zip <br /> Phone <br /> Tenant Mail Address <br /> City State/zip Phone <br /> °15 a L -< uoc,_ q s l08 6 0 b <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> aak,-� tt�� �� <br /> State License Number(required) 0,Q <br /> City of Everett Business License Number(required) <br /> Proposed Use of Building-- <br /> ag3bO <br /> Contract Price of Work <br /> Square Footage (If residential new construction, remodel or addition 1 <br /> Contac`Person/ ontact Number/Email p <br /> Number of devices(If low voltage) <br /> Description of Work to Be Done: I � C`� r v A - <br /> • } r� 1 }� <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 FEL <br /> I hereby certify that l have read and examined this application and know the same to be true and �• <br /> conrect. 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 <br /> violate or cancel the provisions of any other state or local law regulating construction or the PEF2MIT# <br /> petfonnance of construction. That lam authorized by the owner of this property to perform the El(� "V 1 14U( 1" b(-4 <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and ` <br /> 2'•,.200 WAC. <br /> • <br /> SignaturePS G <br /> REVISED 08/0 6420 1 4 <br />