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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.gov <br />i(� 1 t� t�-1�� ������-l�. c��� � E.v�.� _�-_ ���� <br />PROJECT ADDRESS <br />���;-���� <br />�cw�. cc� , o�(..cC?`� <br />�:���,-�c r �-� �� 1��. \ C>1 1 `� ���i -, �.v 9-('2� �.b��`_i <br />Owner Mail Address City State/Zip Phone <br />.��C ',;�L'Yl '� <br />Tenant Mail Address City State/Zip � P <br />�-ia � -�,`��� <br />' � ��� <br />I 1''1►�C� U c.� �..� � �.d �c�Y� c�� 1 r-,c � �� C� ��X �'l3 � � , ��, � �.���`�i <br />Electrical Contractor Mail Address City State/Zip Phone <br />P i�i n,�. � �% ���_ � U �� � i� � <br />State License Number (required) <br />'a `�� �-� i �v�v`.r 1� <br />Proposed Use of Building <br />11� ��, �'k - <br />Square Footage (I sidential new construction, remodel or addition) <br />� <br />Number of devices (If low voltage) <br />���� �� <br />City of Everett Business License Number (required) <br />��`_1�'Ci <br />Contract Price of Work <br />�,uw� v-� ._ ; ��� Zc-r \�� <br />�--t =�4, �.�,v �-� � <br />Contact Person/Contact Number/Email <br />ry� +s <br /><. ���� � , <.�: �< n�re� ���� �� 2 <br />� � a �--� L , �-n=: , <br />�i 7!7 � vv� D I�r� „� � <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <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 nof presume to give authority fo <br />violate or cancel the provisions of any oiher 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 <br />work for which application is made and I comply with the State Contractors La 18.27 RCW and <br />296.200 WAC. ,�� <br />��—, �.�l.r.rv�� ���.���� /'G��? /`� <br />REVISED 08/O6/2014 <br />FEE <br />��1� ���' <br />.� <br />� <br />PERMIT# <br />Ei5 ��0 <br />