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ELEC CAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 — t4./ i,o-e <br /> 4 ve re-44-e SLJ <br /> - <br /> J j <br /> PROJECT ADDRESS <br /> Owner Mail Address City State/Zip Phone <br /> Gi w�r`' S-U" <br /> Tenant Mail Address City State/Zip Phone <br /> (Atov' C'b <br /> l, �t, �j <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> State License Number(required) City of Everett Business License Number(required) <br /> tom!�"�izm.-l'j—Is �,k <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: SfiS"AviNu' <br /> A"T-yi (4A, C.I K�. <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE 13 3105 <br /> 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 <br /> performance of construction. That/am authorized by the owner of this property to perform the E 19cq -on <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> Signature Date <br /> REVISED 0810612014 <br />