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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 <br /> 2, 3o M ci leo 1.1 S x_ <br /> PROJECT ADDRESS <br /> c5U-r �3o h-c�r.(,�o tisk' ey e/P 1 ' <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> ow ne,K <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> State License Number(required) City of Everett Business License Number(required) <br /> SPR <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) Add ,I c <br /> Description of Work to Be Done: �d d L 1 ��1- �� r 1� %4 1{- t VA <br /> cc 2 for' <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105C J X00 <br /> I hereby certify that I have read and examined this application and know the same to be true and —?V <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 �l iq r }U� <br /> performance of construction. That i am authorized by the owner of this property to perform the EM 5V <br /> work for which application is made and 1 comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> Signature Date <br /> REVISED 08/06/2014 <br />