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ELECTRICAL PERIVII°T APPLICATIOIV <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 />�S f e l U� <br />(� � l� �� /�'�� �r z^;� �� �v�� ��C <br />PROJECT ADDRESS <br />���t i,,_ �T � `� � <br />� <br />-T <br />��� �`�- �� ��1 � � _� G't,�L� �'�—�G_ <br />Owner Mail Address City State/Zip Phone <br />r- <br />� �� � �_ � <br />Tenant r <br />�' .. <br />0 <br />Mail Address <br />Electrical Contractor Mail Address <br />C"- t/1/�-'�--�-- <br />C� State/Zip <br />�� U �- Z- 7 7'� � f� 'v'�-� 'vt% •' <br />; ��� �.� � � <br />`� i l�" �) � � .� � /� �' �� <br />State License Number (required) <br />(.:% � U� � i,,� � f�t a Z�.,i <br />Prop��e of Building <br />Square Footage (If residential new construction, remodel or addition) <br />State/Zip <br />Phone <br />!�� � 7y � � �o <br />������� <br />Phone <br />C�`��//� <br />City of Everett Business License Number (required) <br />G, �-�� c�� _�-- <br />/, <br />Contract Price of Work <br />Contact Person/Contact Number/Email <br />Number of devices (If low voltage) <br />Description of Work to Be Don�I� 2- b l�{ Z- ��� � a ��� r C' �D �z �- S L C- �',�" L �c %/�� /� �-i �'� �S <br />�� � t�,�. ��, s J� <br />�,S� -,( /, _. j Z13 1% � � /'�� �/ � <br />(� C'1 � G�� /� � �' � t_ J -t' cC �l%' l� (� rl i,� ��� �v� i��•' (J � S ( �' X - L_. �'t �,J . � i�'1 � � <br />\. <br />�/ � �� !/l <br />t <br />� � ,. <br />Q �' i `� '� � '�- �, v t c'-L � _ �-_ C-� , v� C- e�t �� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby certify that I have read and examined this application and know ihe same to be true and <br />correct. Al! provisions of laws and ordinances governing fhis type of work will be completed <br />whether specified herein or not. The granfing of a permit does not presume to give authority to <br />violate or cancel the provisions of any other sfate or local law regulating construction or the <br />performance of construction. That I 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 />� i -% / <br />�' - i �' �.. . �� -�,�� �/ �/ `/ � `_ <br />�,- -� C__ � . / / <br />Signature <br />REVISED 08/O6/2014 <br />Date <br />�=. �_ �z v� � — <br />� � �> ✓� r�-, C J" <br />FEE <br />I�'���� <br />� � <br />PERMIT# <br />E1�1(-�C�C� <br />