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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVI S <br /> 3200 CEDAR STREET, EVERETT, WA 982 <br /> 425-257-8810 - FAX 425-257-8857-www.ev ettwa.org <br /> �a� � /2-� �� �)� 5� _ � � . <br /> � {�o��h.����� <br /> PROJECT ADDRESS <br /> £� ►^G �ic�� Co»� 5 v�c ,•�c-�'� w� �D� � 7"! S�-v 3 <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address �t State/Zip Phone <br /> �.ce.c.k � I Ga-�'riG 11$ G w � N • ��3 3 ��0�.33 <br /> Electrical Contractor Mail Address Ci State/Zip Phone <br /> X�4GT �l.�iZ7 � k C�5 I7�� <br /> State License Number(required) City of Everett Business License Number(required) <br /> CON�i�O� �`Y-�C_O �� �� i v� <br /> �,� <br /> Proposed Use of Building Contract Price of Work � <br /> _� <br /> Square Footage(If residential new con ruction, rem I ddition) Contact Person/Contact Number/Email <br /> Number of devices(If low voltage) <br /> Description of Work to Be Done: v� b C X-��c.ri a�'' � �� 1�r'G�t)� ,.S <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 � � ��I ��� <br /> (d <br /> 1 hereby cerfify that!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 permif 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 ^ ��� ;:l �� ^ j <br /> performance of construction. That 1 am authorized by the owner of this property to perform the t �v �"� <br /> work for which appli t� made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 C. / <br /> i <br /> g �� �� . <br /> Signature Date <br /> REVISED 08/06/2014 <br />