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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 /> q6oc UtA.9- v <br /> 74-y <br /> PROJECT ADDRESS <br /> fciH-y Tg-1.6(. J . -60-1) 7.2 Si-00- NE EuM- - WA- 4'8 2-7v <br /> Owner Mail Address City State/Zip Phone <br /> Tenant <br /> Mail Address City State/Zip Phone <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> State License Number(required) City of Everett Business License Number(required) <br /> Cbv WJ'(.&L #1000, °, <br /> Proposed Use of Building Contract Price of Work <br /> Orro <br /> Square Footage(If re idential new construction, remodel or addition) Contact Person/Contact Number/Email <br /> Number of devices (If low voltage) C 1a J ,, o, _ <br /> Description of Work to Be Done: Ob6)vu t"'LC- v1�C l� ()emoat\ T& _ eTJz= ,c2 <br /> ConApylAtmt— -ace-e(-)7A61,b <br /> FEE L.� <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 t l D?,— i 0 <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# Q� <br /> violate or cancel the provisions of any other state or local law regulating construction or the E �I Q ®O(� <br /> performance of construction. That I am authorized by the owner of this property to perform the L <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> Ai; <br /> _ Oct— 20-/ <br /> Sign- re — Date <br /> REVISED 08/06/2019 <br />