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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,w& <br /> PROJECT ADDRESS14 it mo , <br /> ?�- �wvC-T <br /> Owner Mail Address City State/Zip Phone <br /> V'� t Vt VIC, Av 0 o Xy e, �jn <br /> Tenant Mail Address City State/Zip Phone <br /> C II I <br /> -7 3v 3 a (o tr � �D��5 67- S <br /> Electrical Contractor Mail Address City State/Zip �(� Phone <br /> r97 / 0d�311� C' 7-3t? <br /> �-f <br /> State License Number(required) City of Everett Business License Number(required) <br /> � � <br /> ��4( L41:43 <br /> 3©v <br /> Proposed Use of uilding Contract Price of Work <br /> d6k qw��� <br /> n IV <br /> Square Footage (If residential new construction, remodel or addition) Contact Person/ onta t Number/Email <br /> e � Gt 1D�N Gw /7 7- <br /> O trn— <br /> Number of devices (If low voltage) <br /> Description of Work to Be Done: t rJ 0 L, 4 e G d" 1 4f <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 00 <br /> /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 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/am authorized by the owner of this property to perform the E <br /> work for which application is made and/compl with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> Signatur Date <br /> REVISED 08/06/2014 <br />