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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 /> PROJECT ADDRESS <br /> f-lel <br /> (D _� - <br /> Owner V Mail Address City State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> Ssr2l 12s <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> () ,5 3 <br /> State License Number(required) City of Everett Business License Number(required) <br /> --11P7f-a-- <br /> Proposed <br /> roposed Use of Building Contract Price of Work <br /> Square Footage(If residential new constructs , remodel or addition) Contact Person/Contact Number/Email <br /> Number of devices (if low voltage) <br /> Description of Work to Be Done: / 6, �c ✓v� q4 <br /> FEE <br /> 0 � <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certify that I have read and examined this application and know the same to be true and <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# <br /> violate or cancel the provisions of any other state or local law regulating construction or the f <br /> performance of construction. T t/am authorized by the owner of this property to perform the <br /> work for wl�'ch a pl'cati is de and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 Gl/ C. <br /> gna ure Date <br /> REVISED 08/06/2014 <br />