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ELECTRICAL. PERMIi 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 />�� � , �� ��� � � <br />S � � � U � �-•i � �� <br />PROJECT ADDRESS <br />� � �� S�,<<�, �c��-.��5 �7 53 ( 1�,�� ��i�ti �,� �—�—>-efi� <br />Owner <br />Tenant <br />Maii Address <br />Mail Address <br />C ity <br />City <br />State/Zip <br />State/Zip <br />Phone <br />Phone <br />fsc�vu�--�cx C`'(�iwr(�Sb(v��., /(� Z l-��S 7„�VE �11� ra �e S�S r �.i� q��� y�� k <br />ElectrlCal ContraCtor Mail Address City State/Zip Phone <br />� d� i1 c�r� �.s 6 7� � T� <br />State License Number (required) <br />�-e�c,� <br />Proposed Use of Building <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (If low voitage) <br />Description of Work to Be Done: <br />ti�3 1�� <br />City of Everett Business License Number (required) <br />v� o-i-o <br />Contract Price of Worl< <br />�; ��..� ���� � �l �S `� Z.'� S L 3 t� <br />Contact P son/Co tact Number/Email <br />� j �� (�,ti(,��,,, � � ��„L � <br />n <br />�-P�►'�P 'Y b w�v �112�J �wV � C� , �v� :� � J J-� � A,n.L �.� �-- <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certify that l have read and examined this application and know the same fo be true and <br />correct. AI! provisions of laws and ordinances governing this type of work will be complefed <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 local law regulating construction or the <br />performance of construcfion. That 1 am aufhorized by the owner of this property to perform the <br />work for which applicafion is made and I comply with the State Contractors Law 18.27 RCW and <br />296.200 WAC. � <br />� <br />Signature <br />REVISED 08/O6/2014 <br />FEE <br />�i`J <br />�� <br />PERMIT# <br />E � ���- ��7 <br />