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GI T Y OF EVERETT PERU(11 n SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org <br /> Vja6,tu,4 Ave, <br /> PROJECT ADDRESS <br /> c-P- Vps s`-{W'O' r evere,� buA . l <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> ' �0 S �t + o"/I <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> State License Number Contract Price of Work <br /> Proposed Use of Building Contact Person (Plan Review) <br /> Square Footage (If residential new construction, remodel or addition) <br /> Number of devices (If low voltage) / <br /> Description of Work to Be Done: <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certify that 1 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 orlocal law regulating construction or the t <br /> performance of construction. That 1 am authorized by the owner of this property to perform the E `�✓ `�I Q 7 7 <br /> work for which apNication is made and I comply with the State Contractors <br /> Law 118.c277JRCW and <br /> 296.200 WAC. f <br /> Signature Date <br />