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u <br />ELECTRICAL PERMIi i4PPLICATIOiV <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 />��� 1� �-�;��. /�:, � <br />PROJECT ADDRESS <br />� { � � v�n �..c; �. <br />Owner <br />,�%� <br />� �_ L�-� v� 5 � �o :.�— <br />Mail Address <br />City <br />�� Z � �?� '_ 6`���5� <br />State/Zip Phone <br />Tenant Mail Address City State/Zip Phone <br />� { (� J � ) ,,f �J ?� �7 �[ <br />��,�,�� �::;.. � � �Cc.SYiC� ���LX� ��1J� � ����C �r �C�J ��-t ZGY ��i�UK'/ �t'L- 1�✓ �GI l�G� ���V� <br />-r <br />Electrical Contractor Maii Address City State/Zip Phone <br />�� �;� C� � i �� �=i � i P5 <br />State License Number (required) <br />���� <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 />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />;� � <br />v� I+�� <br />City of Everett Business License Number (required) <br />I,�;Cv. � <br />Contract Price of Worl< <br />e�,� Z��,. �"11. �f6s <br />Contact erson/Contact Number/Email <br />� �^� � / � � Lv <br />1 hereby certify that I 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 />whefher specified herein or nof. 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 fhe <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 1 comply with the Staie Contractors Law 18.27 RCW and <br />296.200 WAC. > <br />� �/ j/.�� ` 2 � / � <br />re <br />REVISED 08/O6/2014 <br />FEE <br />��� � U <br />PERMIT# <br />E ��02- i�7� <br />