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Mar. 4. 2015 1:39PM <br />No.0502 P. 1/1 <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 />Do <br />PROJECT ADDRESS <br />Rwner Mail Add ess City Stale/zip Phone <br />E'4�-4 I,,' /e /r <br />Tenant V Mall Address. City State/ZIP Phone <br />le rical Contractd Mail Address city State/Zip Phone <br />C'n it S a to <br />Staf L' ense Number (required) City of Everett Business License Number (required) <br />Prop d Wee of auil mg Contract Price of Wor <br />0-0 VVIA LUJ'A40 <br />Square rootage (If residential new construction, remodel or addition) TF;r7/Contact Number/Email <br />N mber of devices (If w Voltage) (/ <br />Description of Work to Be pone: <br />FEE 45C 60 <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3106 6 <br />I hereby certify that I have read and examined this application and know the some 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 ofa permit does not presume to give authority to PERMIT# <br />violate or cancel the provisions of any other state or local taw regulating construction or the <br />performance of construction. That I am authorized by the owner of this property to perform the E r20— <br />work for which application Is made and I comply with the State Contractors Law 18.27 RCW and <br />296.200 WAC <br />Muvxl - <br />Signature Date <br />REVISED O&V&2014 / <br />