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OCT-06-2015 13:06 ELECTRI—CITY 425 672 6799 P.01i01 <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.gov <br /> ��/ <br /> PROJECT ADDRESS <br /> Omer Mail Address City State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> r _ <br /> Electrical ContracT r Mail Address City State/Zip Phone <br /> State License Number(required) City of Everett Business License Number(required) <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) /�� <br /> Description of Work to Be Done: �/yS�w l� 12 7ad 46-D �V1 j4*C -,' <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX COVE IS 3105 4 <br /> I hereby certify that I have read and examined this application and know the same to be true and t <br /> correct. 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 PERMIT#f <br /> violate or cancel 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 <br /> work for which application is made and I comply with the State Contractors I-aw 18.27 RCW and L) V <br /> 296.200 WAC. <br /> 41.4� <br /> 5ignalure Date <br /> REVISED 08/06'2014 <br /> TOTAL P.01 <br />