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• �4i�i ! � <br />ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVIGES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />��c�� �-�.�.� C-.���- P�w� ._ g���.�,►.� �.�..�:) <br />PROJECT ADDRESS <br />�-�e,r,h�a � �!D(J'Lr��cs �li �� �9cJ��� ���[)R-LrU�J� �A _ ��V �� <br />Owner Mail Address City State/Zip Phone <br />Y �1� �..' Q r� <br />Tenanl Mail Address City State/Zip �i�� Phone <br />' � � �; c�� � 5� . o �- � �..o � �a � StJ S2, � <br />�tz-�r�� �'-t.�utZe� }z. �,�153 �'>Mvn�� k k-3G6� <br />Electrical Contractor Mail Address City StatelZip Phone <br />�t'---it �i �: !.' .� v.'�,7 ��.. <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 />Description of Work to Be Done: <br />�a�1 � �i�? <br />City of Everett Business License Number (required) <br />�'�5 � .°� <br />Contract Price of Work <br />��(�k5 �bAo �7i5 � �l S�-(-�3�6.� <br />Contact Person/Contact NumberlEmail <br />�j 0l1,� � P�i° d���c �� /1L •� v%1 <br />d <br />� (10 �2) '�.� c� �� ����J �,<� l � u �,t.'; i� � h � {V� tc a,�e-�, <br />7 � �5 -� �` �° .s, t� i i . ,t ' � i�..,- <br />y� j �;'r:,...r'c� r: . .ww'� t t...j t `i ^`" �.tf;� i`� ,--� � s3�1-4 !�„taf' �"�,a.�.�tr'„�.i''Vt, %; <br />� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />i hereby certify that / have read and examined this appflcatron and know The same Co be true and <br />correct. All provisions of laws and ordinances governing fhis type of work wi11 be completed <br />whether specified herein or not. The granting of a permit does not presume to grve authorify to <br />violate or cance/ the provisions of any other stafe or /oca! law regu/ating construction or the <br />performance of construction. Thaf i am authorized by the owner of this properry to pertorm the <br />wark for which application rs made and ! comply with the State Contractors Law 18.27 RCW and <br />296.200 WAC. _._� <br />�"�� r � t S' <br />nature <br />REViS£D 08/06/201 d <br />FEE <br />(J <br />���-- <br />PERMIT# <br />E15o5 �- I I � <br />