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To <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 /> k1/E�2��TT�PS ® �1lER�n�N�4.�V. <br /> PROJECT ADDRESS <br /> T pOo.Box -37,o7 &W& ,eW 9912412207 --1'z5. a3Z12.2/Z <br /> Owner Mall Address City State/Zip Phone <br /> Tenant Mail Address City State/Zlp Phone <br /> 41,i9Ff'275 <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> State License Number(required) City of Everett Business License Number(required) <br /> ��a moa <br /> Proposed Use of Building Contract Price of Work <br /> & •l� il7iYlF-,�a <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: <br /> 2�/ <br /> L <br /> . FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby certify that 1 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 r 1 I O <br /> performance of construction. That i am authorized by the owner of this property to perform the C <br /> 2-9 <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC., <br /> Lam- / <br /> gnature <br /> Date ___-----.. _ ._.. - — -- --------• —... <br /> GENERAL CONSTRUCTION COMPANY <br /> REVISED 0&OCJ2014 P.O.BOX 46-MUu'LTEO,WA 98275 <br /> 425-294-6944-FAX-425-294-6947 <br />