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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 /> 2-2-16 !23+11 PL SC C\jEtzC�rr tjPr Cg2()0o <br /> PROJECT ADDRESS <br /> RosA 80QT2ft✓Li�, snfy� <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> �)vjij <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> State License Number(required) City of Everett Business License Number(required) <br /> c <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 /> � r17Ze TS <br /> Description of Work to Be Done: �� k/ '4 7 <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 175 <br /> Wt hereby certify that/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# C ISO 3 000) <br /> violate or cancel the provisions of any other 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 which application is made and l comply with the State Contractors Law 98.27 RCW and ��lJ <br /> 296.200 WAC <br /> Sign I Jule k Date <br />