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ELECI KICAL PERMIT APHLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 — jzQv" <br /> e, L 6-,r e-4 4 'p 5 a-v e-p'j Zcp, <br /> PROJECT ADDRESS <br /> -ERA F D 91 <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> r4tDu <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> 1;1 L 6 0 LI)71-i L- 'I <br /> State License Number(required) <br /> -City of Everett Business License Number(required) <br /> y f� <br /> Proposed Use of Building Contract Price of Work <br /> 7� G-W-r,rtFJ <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: U <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> lhereby certify that/have read and examined this application and know the same to be true and J <br /> oc <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 <br /> work for which application is made and/comply with the State Contractors Law 18.27 RCW and <br /> if ll� <br /> 296.200 WAC. <br /> L�—v---I- <br /> olyridwre <br /> Date <br /> REVISED 0610612014 <br />