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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 />�, <br />( n n � ' �`( �L c. <br />( (� ��� � �«� �,��. �I �u.� � V � i <br />PROJECT ADDRESS <br />,'��� ��� ;� ; .: r�_ �� <br />Owner <br />l� <br />Tenant <br />,'���u � (�.c��Cli <br />M il Ad'a dress <br />Mail Address <br />City <br />City <br />�.�'��� 1�,� L���;�,��;: ��/� �i���-r(����)���r-�� <br />State/Zip <br />State/Zip <br />Phone <br />,, � <br />Phone <br />�-, - <br />[�?��,� `��'c���►� � �< �r;�,;� '1,.� ��X �� `�L `�� Zchtirv„56) �,�r `-��,c�c7� ��� �4i- �l�c� <br />Electrical Contractor Mail Address City State/Zip Phone <br />l n <br />�L-_;��`�`�LLCiS`���t � i� <br />State License Number (required) <br />Proposed Use of Building <br />Square Footage (If residential new construction, remodel or addition) <br />.� <br />Number of devices (If low voltage) <br />Description of Work to Be Done: ��� >�'V/� �� <br />( � �` S Z �: �-� <br />City of Everett Business License Number (required) <br />`�� �—t'�i ����-. <br />Contract Price of Work <br />f ��'ri c �e �(Z� = Z� � �Z i 2 �i �u.l I��� r�'r�rf� <�v �,�,,. c; �� <br />Contact Person/Contact Number/ mail, <br />1��. <br />�fCX �v `�..�5"t�,r'� ' (', ; <br />;� J i <br />���.��nc�-�l�t,`i� `5 (���,���--�-���{'�C'��iC�� ��'���E���'l � <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 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 local law regulating construction or the <br />performance of conspPuction. That 1 am authorized by the owner of this property to perform the <br />work for which appli� tion is made and 1 comply with the State Contractors Law 18.27 RCW and <br />296.200 ; C. /' � <br />��, /�, �� ��� �.. <br />,�� -��� �1 lt 1� <br />Si ature ." Date <br />REVISED <br />FEE b <br />l� � <br />PERMIT# <br />E �-15�� y �� ( <br />