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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 /> 21-1to rnccsafie, Z 1 E~04-1 W64 ctoZOr <br /> PROJECT ADDRESS <br /> 1Y6v'i 2 F° t.©�.. I OS &m, I./t>` i `?2520 <br /> Owner Mail A ss City State/Zip Phone <br /> Magri IW e St <br /> Tenant MaiWddress City State/Zip Phone <br /> �W <br /> Otr <br /> Electrical Contractor Mail Ad ess City State/Zip / Phone <br /> l` <br /> f / <br /> r <br /> State License Number(required)/ City of Everett Busies License Number(required) <br /> / <br /> Proposed Use of Building/ Contract Pfri a of Work <br /> Square Footag (If residential new construction, remodel or addition) C tact Person/Contact Number/Email <br /> Number of devices(If low voltage) <br /> Description of Work to Be Done: kl E 6 - 200� _C'`s vp Cf <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 ( <br /> 1 hereby certify that I have read and examined this application and know the same to be true and 00 00 <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 <br /> performance of construction. That I am authorized by the owner of this property to perform the :f <br /> work for which a 'cation is ':we an. I co .ly with the State Contractors Law 18.27 RCW and ` r <br /> 2ZX <br /> I8 2 6s° <br /> Si• ature4111, Date <br /> REVISED 08/06/2014 <br /> 0 <br />