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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 /> *43 57i2' /.41 <br /> PROJECT ADDRESS <br /> /f`l G�reef <br /> /3)/k .5 /c7) 35-N 6}- 7za- oi^ �c>e✓' f/Z W4 ?gZ.o( z5-2--C993 <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> VAC- <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> • <br /> State License Number(required) City of Everett Business License Number(required) <br /> Proposed Use ofBuilding Contract Price of Work <br /> /5. 36 <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: Ca/ �^�/ � /C-C-//('G 4- .1`7)4 4 r- <br /> 0-7 <br /> ,Qr4, � <br /> • <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105SO <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 ��D <br /> performance of construction. That I am authorized by the owner of this property to perform the EC <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> 93-11/1-"z ///W/Clgnature Date <br /> REVISED 08/06/2014 <br />