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:ELECTRICAL PERMIT APPLICATION <br /> � � � <br /> . 'CITY OF EVERETT PER``MIT `SERVICES `: <br /> 3200`CEDAR STREET,'EVERETT, UVA 98201` <br /> 425-257-8$10 - FAX 425-257-8857—wvuw.everettwa;.org <br /> ��� e(��� � U � <br /> PROJECT ADDRESS . <br /> ,� �/� �j �V�°Iz��ti � .� . <br /> , � <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address City - State/Zip Phone <br /> �i�z�� ��.�1 �/9�2 l�si �-�„� �vl��1i�� �� ��S <br /> Electrical Contractor Mail Adtlress City State%Zip : Phone <br /> ���� �S q s��9 <br /> �G.zs-��� �s ,� :: <br /> State License Number(required) City of erett Busin s License Number(required) <br /> 3 S1� - <br /> Proposed Use of Building Contract Price of 1Nork <br /> Square Footage(If residential new construction, remodel or addition) Contact Person/Contact Number/Emaif <br /> Number of devices(If low voltage) <br /> Description of Work to Be Done: In� : �(���/J�� �v0 m e ��C�- <br /> /'�r..�c� �1��.� G1�14�� C�� <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 �/�j, �� <br /> t / <br /> I hereby certify that I have read and examined this application and know the same to be true and <br /> correct. All provisions of laws and ordinances governing this type of work will be comp/eted: ` <br /> whether specified herein or not. The granting of a,permit does not presume to give-authority to PERMIT# C/,J l,�0$`�'d,/ <br /> violate or cancel the prov�sions of any other state or/oca/law regulating construction or the` �c� , I� ��� <br /> performance of construct�on. That I am authorized by the owner of this pro,perty to perform the ��-- <br /> work for which application is made and 1 comply witli the State Contractors Law 18.27 RCW and <br /> `296.200 WAC. <br /> �--- <br /> c�e, � c�,�:� - -1� <br /> Signatur Date <br /> ; <br /> REVISED 08/06/2014 <br />