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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 425-257-3857 — www.everettwa.org <br />PROJECT ADDRESS q <br />Owner Mail Address City State/Zip Phone <br />�c tv�rrn_ �(&p1 I `l ,t"� �, �Z,� text �cnd <br />Tenant <br />/�/� n� Mail Address City State/Zip Phone <br />0W i <br />Electrical Contractor Mail Address City State/Zip Phone <br />State License Number (required) C it of Everett Business License Number (required) <br />1-- -2.c-:D <br />Proposed Use of Building Contract Price of Work <br />Square Footage (If residential new construction, remodel or addition) Contact Person/Contact Number/Email <br />Number of devices (If low voltage) A <br />Description of Work to Be Done: \'BCJt��1ua L\\Y COZY (N SSOY <br />FEE k <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 1P <br />I hereby certify that I have read and examined this application and know the same to be true and JJVV <br />correct. All provisions of laws and ordinances goveming this type or 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 constmclion. That lam authonzed by the owner -of this property to perform the E r I1 �- <br />work for which application is made and 1 comply with the Stale Contractors Law 18.27 RCW and <br />296.200 WAG <br />Signature Ili Date <br />REVISEDO&OW010 <br />G16-10 <br />