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ELECTRICAL 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 /> W.jA, <br /> PROJECT ADDRESS <br /> PpCi5)-, <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> Nv^ rl cam) �� �F � �,� ��,� �3�;� <br /> Electrical Contractor Mail Address City Sta /Zip Phone <br /> State License Number(required) City of Everett Business License Number(required) <br /> Proposed Use of Building Contract Price of Work <br /> v 6✓' ,A Ja1— Awvc "tru, _)at <br /> Square Footage (If residential new construction, remodel or addition) Contact Person/Contact Number/Email ^/ <br /> Number of devices (If low voltage) 1 <br /> Description of Work to Be Done: iv F o---m UW � r 0�, � IJ�'h <br /> �l�..►�--� �� �if�l� r�L- '1�-- /mow �� �I�l�(l tWex�4-�� <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 oac) <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 1�� 1 O—i <br /> performance of construction. That/am authorized by the owner of this property to perform the <br /> Co <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296. 0 WAC. <br /> 7/ <br /> ignatur Dat <br /> REVISED 08/06/2014 <br />