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1 <br /> 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 yZ�' 77 0;� <br /> Cern muxv tL kms-- Yv &ffW-F�W^ p`f-Q iso ?5Z23 <br /> Owner Mail Address City State/Zip Phone <br /> 544f Yf <br /> Tenant Mail Address City State/Zip I/Z� �g 76� <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> ?71A Cl (2 W 6 Q 3 <br /> State License Number(required) City of Everett Business License Number(required) <br /> Proposed Use of Building Contractrc <br /> yzs-zs� <br /> ,A, /A SeP / wI <br /> Square Footage(If residential new construction, remodel or addition) Contact Person/Co ct Number/Email <br /> NIA - ex a" <br /> Numbero d ices (If low voltage) <br /> Description of Work to Be Done: N �J�'� �f!V� 6Rb0kr2!001V1 <br /> CUBICLE-'s 1570-0W)E -VCZ-OSe�) <br /> FEE �� <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 oV <br /> r <br /> l 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 �lYr, <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WA <br /> lN� � 16 > <br /> Signature Dat <br /> REVISED 08/06/2014 <br />