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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 /> PROJECT ADDRESS <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail 'Address n City State/Zip Phone <br /> 0 l o rYly �l z'c��r f7� `�2i'1117"5 P � ���J( L7rA.At k- (:.J(9 i j %/�-7Z Lz <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> State Ificense Number(required) City of Everett Business License Number(required) <br /> Proposed Use of Building Contract Price of Work <br /> 10 '�U,W 5s ,7>-31& - 7.>z7 <br /> Square Footage(If residential new construction, remodel or addition) Contact Perso /Contact Number/Email <br /> Number of devices (If low voltage) <br /> nil lrs P t� Cya d (-o-nty 1 � 11 L—j <br /> Description of Work to Be Done: �5J��( f ' <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 3615 <br /> I 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 goveming 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 i /� <br /> performance of construction. That/am authorized by the owner of this property to perform the E V <br /> I '� 3 <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 08/06/2014 <br />