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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> �-- 425-257-8810 - FAX425-257-8857 —www.everettwa.gov <br /> PROJECT ADDRESS <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> OeC72 it i55 N 0! 12L AOQU;� ,,D (84- ST Z23 yZ5-35g-6Y1,j" <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> State License Number(required) City of Everett Business License Number(required) <br /> fru`, (Y'\a kms' � � '�� <br /> Proposed Use of Building Contract Price of Work <br /> \hA LU&,Ott <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: 4AA Qbm C"7 ccs �—rs li�)� <br /> (WOClti`t <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 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# <br /> violate or cancel the provisions of any other state or local law regulating construction or the <br /> performance of construction. That 1 am authorized by the owner of this property to perform the El <br /> work for which application is made and/comply with the State Contractors Law 18.27 RCW and 11UII000 (J <br /> 296.200 WAC. <br /> -721 2 <br /> Dater <br /> REVISED 0810612014 <br />