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10/19/2015 10:31 FAX 425 257 8857 EVERETT PERMIT SERVICES lJ003/003 <br /> • i <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 /> I SQ_),gym <br /> PROJECT ADDRESS <br /> C o ick 4c3 m@.s 9 y-)e 315-1- nN 5 6 C.ze_ yu R °_ _a os- <br /> Owner <br /> s- <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> (36D) <br /> • ( ' :00 c <br /> Electrical Contractor Mail Address City State/Tip Phone <br /> G.P\ Kvs E-rAic'i i c; 039 l u <br /> State License Number(required) City of Everett Business License Number(required) <br /> Proposed Use of Building Contract Price of Work <br /> Square Footage(If residential new construction, remodel or addition) Contact Person/Contact Number/Email <br /> Number of devices(if low voltage) <br /> Description of Work to Be Done: W1 {e p� <br /> • <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 426-io ° <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 I O��� I <br /> performance of construction. That l am authorized by the owner of this property to perform the <br /> work for which application is made and l comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> (i l icbt(7E13 J// <br /> Signature Date <br /> REVISED 08806/2014 <br />