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ELECTRICAL PER, 40,111T APPLICATION <br /> CITY OF EVERETT PERISIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 25-257-8690 FAX 425-257-8857—w�vvv.everetti�,,,a.gov <br /> PROJECT ADDRESS <br /> i Q1. S�J R_,j der'kq <br /> Owner Mail Address City State/ZPhone <br /> Tenant Mail Address city State., ip Phone <br /> 6r, r, :Iw� <br /> r3 <br /> 2"411 (AC5 �Liq n,t Ut e", 61., <br /> Electrical Contractor Mail Address City state/zip Phone <br /> State License Number(required) City-of Uvqett Business Licpse Number(required) <br /> Proposed U§6 of Building I 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 voltagef <br /> (A <br /> V <br /> FEE <br /> CITY OF EVER TT LOCAL SALES TAX CODE 18 3105 0 O�©� <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 <br /> performance of construction. That/am authorized by the owner of this property to perform the E D "27 <br /> work for which application is made and/comply with the State Contractors Law 15.27 RCW and <br /> 296-200 WAC. <br /> -Signature Date <br /> HE Vl$�.Q Q4P,,WQ1 4 <br />