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03/31/2016 01 : 56 #0223 P. 001/001 <br /> 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 /> PROJECT ADDRESS <br /> Owner Mail Address City State/zip Phone <br /> Tenant Mail Address City State/zip - Phone <br /> Electrical Contractor <br /> IUail Address City State/Zip Phone <br /> Eli ANSA 0i (a 3 ( 3 <br /> State License Number(/squired) City of Everett Business license Number(required) <br /> GGA m a. C� _ <br /> Proposed Use of Building Contract Price of Work <br /> Square Footage(if residential new construction, remodel or addition) Contact <br /> ontact� Num <br /> mb rl mail <br /> —il <br /> Number of devices(If low voltage) <br /> Description of Work to Be Done: <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX COBE IS 3106 r/l <br /> I hereby certify that I have read and examined this application and know the some to be true and t�D C70 <br /> correct. All provisions of laws and ordinances governing this type of work will pe,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 iothvr state or local law regulating construction or the <br /> performance of construction. That/am authorized by the owner of this property to perform the E <br /> work for whlc a plication is made and/comply with the State Contractors Law 18.27 RCW and ✓✓ l <br /> 296.200 W <br /> Signature Date <br /> REVISED oaromaoi a <br />