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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 /> 1?1i/-� � J a I. F <br /> PROJECT ADDRESS <br /> Owner Mail Address City State/Zip Phone <br /> 5/1P1 t <br /> Tenant Mail Address City State/Zip Phone <br /> 0 WN 9 <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> State License Number(required) City of Everett Business License Number(required) <br /> �c 10 F- 07r'4 L <br /> Proposed Use of Building Contract Price of Work <br /> f-�)&FArr/-1- r45c�/ltC"700'%- Gor,�pri� ✓;- <br /> Square Footage (If residential new construction, rerfiodel or addition) Contact Person/ ontact Number/Email <br /> Number of devices (If low voltage) /J <br /> Description of Work to Be Done: (Lf—C (`' 1 elf- . x, ty^ F9& <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> i <br /> I hereby certify that l 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 orlocal law regulating construction or the E �b�H L 0 <br /> performance of construction. That I am authorized by the owner of this property to perform the <br /> work for which application is made and 1 comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> pn��e <br /> /S <br /> Signature Date <br /> REVISED 06/06/2014 <br />