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E <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 FAX 425-257-BB57—www.everettwa.gov <br /> D Vili✓4:4 Ace- <br /> PROJECT ADDRESS f -3 7 <br /> nRel& C.r k 12�' ��1 t SIZ& <br /> Owner 1 /n Mail Address City State/Zip Phone <br /> iTenant, Mail Address city Stata/Zip Phone <br /> /�l���co' {✓�PC 12� _ �7ZCa I ��`. l� �: c�� f� � a t-177/ <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> State License Number(required) City of Everett Business License Number(required) <br /> 17 12150 <br /> Proposed Use of Building Contract price of Work <br /> Square Footage(If residential new construction,remodel or addition) Contact Person/Contact Number/ mail <br /> Number of devices(If tow voltage) <br /> Description of Wont to Be Done: <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE <br /> I hereby certify that/have read and examined this application and know the some to be true and <br /> correct. All provisions of laws and ordinances governing this type of work will be completed <br /> whether specified harein or not. The granting of a permit does not presume to give authority to PERMIT# <br /> violate or canoe/the provisions of any other state or local law regulating construction or the <br /> performance of construction. That I am authorized by the owner of this property to perform the E O&vi <br /> work for which Application is made and I comply with the State Contractors Law f 8.27 RCW and �` <br /> 296.200 WAC_ <br /> D- 110 <br /> Signature Date <br /> REVISED O8/OB Of4 <br /> Za•/TB 39tid �I�1���� 2��QN � 998ZZ955Zb 8T 9T 9TaZ/aT150 <br />