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� � <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 />�����✓' � ��-�V�}� �`�� <br />PROJECT ADDRESS <br />%;� � ���� �, � � <br />Owner <br />Tenant <br />Mail Address <br />Mail Address <br />�i <br />�r <br />(.'; G� , �:`'i;'. <br />. <br />� '�'.✓i=' 'N <br />C ity <br />C ity <br />�.�� , `��� �� �l <br />R.. ��.�� �.. �' LJ <br />State/Zip <br />State/Zip <br />Phone <br />Phone <br />�' "` � l� � � �r � l )� l ��n �'i� � 1,� � Z 3 ��� --�`'�t t'!��'� <br />�+��r�^� .�G-��.� �` � '�� ��_i�� �' �! <br />Electrical Contractor Mail Address City State/Zip Phone <br />���n��������� <br />State License Number (required) <br />Proposed Use of Building <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />Description of Work to Be Done: <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />City of Everett Business License Number (required) <br />Contract Price of Work <br />Contact Person/Contact Number/Email <br />I hereby certify that 1 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 <br />violate or cancel the provisions of any other state or /ocal law regulating construcfion or the <br />performance of construction. That 1 am authorized by the owner of this property to perform the <br />w,8rk for which application is made and 1 comply with the State Contractors Law 18.27 RCW and <br />�9�200 WAC. <br />�.- <br />re <br />REVI SED 08/06/2014 <br />FEE � <br />��5 <br />PERMIT# <br />E ���� � b� 5 <br />