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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 /> Ev"E-M w4 992x3 <br /> PROJECT ADDRESS <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> PC) SDx 2315 L4klA oe 91036 —23 '7-5-- <br /> Electrical <br /> 2375Electrical Contractor Mail Address Cit State/Zip Phone <br /> 'fL 5- 73 7 8Y6 <br /> P o s3s3 s- <br /> State License <br /> Number(required) City of Everett Business License Number(required) <br /> Sfnat'c fi�..�f�u �i6P" (oSOO •o 0 <br /> Prop ed Use of Builcting Contract Price of Work <br /> Gv !,aj ff a X/C9 y2s-7.37 <br /> Square Footage(If residential new construction, remodel or addition) Contefct Person/Cont t Number/Email / <br /> Number of devices (If low voltage) J <br /> Description of Work to Be Done: MOye 2![C4%C/ .Seg-I/ t o.r+ b4e4 <br /> /_ <br /> �/' �J✓1� , /lQ4�i/L L�r1oIJ a.1� v�G AYsv�t�d� MZJ (J&- ) <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <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 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 I (0— 13-7 <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 />