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ELECT�CAL PERMIT AP ICATION <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 />1=� 12 �. ��Y�C��:�n �CJ � �t�2-�fic �I'z-;Z�:S <br />PROJECT ADDR SS <br />� � <br />Owner <br />49 <br />Tenant <br />Mail Add <br />l" <br />Mail Address <br />C ity <br />City <br />°�� <br />State/Zip <br />;�ti 7 1 <br />State/Zip <br />Phone <br />Phone <br />����/k`� Q11"�'�t,�l� �l�'�:r�1.ic; �'��31 � l'' Ptl/E, S� G�1��`� vr��'� � � � ����1 '�-�`�—� '3�� - 3���� <br />Electrical Contractor Mail Address City State/Zip Phone <br />''���� ��� V V �� � ��� <br />State License Number (required) <br />Q-�� i C���'�i:�rn, <br />Proposed Use of Building <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />� ���� �� L� <br />City of Everett Business License Number (required) <br />�� � � p �`�tl I� <br />Contract Price of Work <br />1� � �if !�l �?�-f � �- �..�1�io �? � <br />Contact Person/Contact Number/Email <br />T���Ti������C-��%I �i �'� �l� <br />Description of Work to Be Done: �C�,�U� �� � _ �1,/l,•�� G',- ��s(,�(,,j �� <br />�,t� � i� � 11'r'� (.��,�� f �Yl-S . I ��7 r�.� !%�'`� <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 construction. That 1 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 Law 18.27 RCW and <br />296.200 WAC. <br />�blr'� <br />REVISED 08/06/2014 <br />FEE <br />� 0 °� <br />PERMIT# <br />E �������� <br />�� <br />