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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 /> 3Avo � z <br /> Owner Mail Address City State/Zip ZDphone <br /> Tenant Mail Address City State/Zip Phone <br /> N0i'l T- �/,PC-, Aba-W V5W -tL 4�,Y(" t 2— <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> Pz� S C- 2- 7 x i+- (D V K I f <br /> State License Number(required) City of Everett Business License Number(required) <br /> Proposed Use of Building Contract Price of Work <br /> ti:4- -7-5A 14D')P-e � <br /> Square Footage (If residential new construction, remodel or addition) Contact P r on/Contact Number/Email <br /> —f"o . l�1700Q2/� ,�.,cAS7: <br /> Number of devices (If low voltage) <br /> Description of Work to Be Done: <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 f) <br /> I <br /> hereby certify that 1 have read and examined this application and know the same to be true and `-' J <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 <br /> performance of construction. t 1 am authorized by the owner of this property to perform the E c5 o <br /> work for which applicati I made and 1 comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. og�00' <br /> Sin r Date <br /> REVISED 08/06/2014 <br />