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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 />� <br />G .� �oG ,I �l � Pr, �� �rPc�< I � r ►�"i,.�P -/ � �� ; �� <br />PROJECT ADDRESS <br />Owner <br />Tenant <br />Mail Address <br />Mail Address <br />City <br />City <br />,�- yGC <br />State/Zip <br />State/Zip <br />Phone <br />Phone <br />��1 t( i �� �G � G,��'G�f , L /�il • �%C`u�( �� _J A � �C�,.., � h W�Y� �3'G� `� / �l�.�11�"�7�"' <br />EleCtriCal Contractor Mail Address City State/Zip Phone <br />�i S'S aC� � c�8rnr�. <br />State License Number (required) <br />c>-?`�; r� /��� r� l, 4-�� <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: � Wt' �. <br />� C� y '7 l.. `i <br />City of Everett Business License Number (required) <br />� j+ l" �� s' � v <br />Contract Price of Work <br />�cr� y ���c��r>n � <br />Contact Person/Contact Number/Email <br />/`'A n�C`'-, ��^� ,;�.J'1 K� t".�r.7t' �� I�t 17{,�C , h G' / <br />hr/ �� ��C'�JlPti �,n f,"�C� �d+(,. <br />��CCn '71'�c /t�J' <l f /1 � C ('. -�.. J. � �''1 '�� l ll c� � h1't�• �G rc,u/ti .. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certify that I have read and examined this application and know the same to be true and <br />correcf. All provisions of laws and ordinances governing this type of work will be completed <br />whether specified he�ein 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 fhe State Contractors Law 18.27 RCW and <br />296.200 WAC. � <br />� <br />L <br />nature <br />REVISED 08/06/2014 <br />FEE <br />���� �S <br />PERMIT# <br />E �' �0`��- � `� �' <br />