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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 /> /6r <br /> z7/5--- <br /> / <br /> 45/ Ai 1440 7:?/tri <br /> PROJECT ADDRESS <br /> Ca- e-. I <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address CitaL6M 73/ y �Statte/Zip one <br /> / <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> e v-4E <br /> 3---O <br /> State License Number(required) City of Everett Business License Number(required) <br /> Proposed Use of Building Contract Price of Work <br /> FOO <br /> Square Footage(If residential ew construction,remodel or addition) Contact Person/Contact Number/Email <br /> Number of devices(If low voltage) �/ <br /> Description of Work to Be Done: AD <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105i� O o <br /> /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 - •-1 the provisions of any other state or local law regulating construction or the <br /> perform- ce of onstru tion. That 1 am au orized by the owner of this property to perform the EI �Q' <br /> work f• which a oplica n is e an r• ply with the State Contractors Law 18.27 RCW and ,j1 <br /> 296.210 WAC. <br /> Signature Date <br /> REVISED 08/06/2014 <br />