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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.org <br />�,�,�� o ���ri I ( Gr� Pr,��v��� �.3eo <br />PROJECT ADDRESS <br />� � � t;�. <br />Owner ' Mail Address <br />U <br />City <br />State/Zip <br />Phone <br />c <br />l 1ir(1 v1 ,.<� .>C� C�1 � � t t i� C� I� 2.'�- �� C�t� ��� IJ� r r�-{�� L�f� �`�`�c�� <br />Tenant Mail Address City State/Zip Phone <br />Electrical <br />.S l G� ✓1 �y S fe � ��i 8 U l I U��'i9s o � 1�e�n - L�r' C� ��'Z '� (, V1�`} � <br />Mail Address <br />(����.Y��s �s3 �.�1 �- <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 />City <br />State/Zip <br />�a �,; ; �fas� 33� ��3s- <br />Phone <br />��' `� �( � �L <br />City of Everett Business License Number (required) <br />f �'�-'� `'= <br />Contract Price of Work <br />�lu k� tS ����� <br />Contact Person/Contact Number/Email <br />��i,�3�!'fMi fs'Cal'���Y'c�S��.9S�,StN/�•S.Cc;� <br />Description of Work to Be Done: �I ��C �L ��io /�U �� (� �' (�� �� �t �� 5i�i11. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certify that 1 have read and examined this application and know fhe 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 l am authorized by the owner of this property to perform the <br />work for which application is made and 1 comply with the State Contractors Law 18.27 RCW and <br />296.200 WAC. <br />Signature <br />REVISED 08/06/2014 <br />Date <br />FEE <br />�i � <br />PERMIT# <br />� <br />E �.�� �� � �' <br />