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�L�CTRICAL P���VII°� AF'PLICATION <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 />� �"J Q l.� 'v� l'.�'i J� C�'G W � � V I� C� C� (� <br />PROJECT ADDRESS <br />�� <br />Owner <br />Tenant <br />� ��1�� <br />Electrical Contractor <br />c� U-I �r{r I � <br />Mail Address <br />Mail Address <br />Mail Address <br />.S'� )L � �, `� z `�1 I � Cx� __5 <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 />-�I`�� �Vs�K��7t, ���. <br />City <br />City <br />City <br />State/Zip <br />State/Zip <br />State/Zip <br />��?Z� � <br />Phone <br />Phone <br />Phone <br />City of Everett Business L.icense Number (required) <br />=_� � J C����; <br />Contract Price of Work <br />� l� �-� 2�, (,� � _3`; �,.;� �J <br />Contact Person/Contact Number/Email <br />/7 <br />Description of Work to Be Done: � 1'�� �j`�i�i ��— L4��''� i''�'��"" ��-'{ ��+�, �� C G C,-� f_� ]� �_ <br />, <br />� <br />� �1���:���. C � °'� � � <br />CITY OF EVERETT LOCAL SALES TAX CQDE IS 3105 <br />I 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 />performarice of construction. That 1 am authorized by fhe owner of this property to perforrn the <br />work for which application is made and I cornply with the State Contracfors Law 18.27 RCW and <br />296.200 WAC. <br />� � %% 'f/l� <br />c <br />Signature <br />REVI SED 08/O6/2014 <br />FEE <br />��,- -7 c� �; <br />PERMIT# � <br />E I�(�- �C>C� <br />