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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 />�l �% ( G(�c�S 1'rL' _ <br />PROJECT ADDRESS <br />��( <br />Owner <br />Tenant <br />M�c <br />Electrical <br />��t-{��1= !I 6 J CG <br />Mail Address <br />Mail Address <br />,, �C. �4 tN� 3�� <br />Mail Address <br />!�i C� � �� C C ��� t� .� <br />State License Number (required) <br />s �,� <br />Proposed Use of Building <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />City <br />C ity <br />�S( <br />:i <br />City <br />-�; � `/Z� 3-�-�_ _�5(c� <br />Stat /Zip Phone <br />State/Zip Phone <br />r <br />� A'Y�r �i � �l� 0 l'f�r �`�`^�— i <br />State/Zip <br />Phone <br />� ��'—�`fCy <br />City of Everett Business License Number (required) <br />� � L1 C,j <br />� iG� . <br />Contract Price of Work <br />Contact Person/Contact Number/Email <br />Description of Work to Be Done: I r� i 5���'�� 7J C=�v i�a � 1����,11-'� � i�1�r�.Q.� \ �"�i� <br />�'N t—� � ' �Svvt '1L,k� <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 />correct. All provisions of laws and ordinances goveming this type of work will be completed <br />wheiher specified herein or not. The granting of a permit does nof presume to give authority to <br />violate or cancel the provisions of any other stafe or local law regulating consfruction 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 the State Contractors Law 18.27 RCW and <br />296.200 WAC. <br />re , <br />REVISED 08/06/2014 <br />/.�—y —/5 <br />FEE <br />`�' ��� x�i <br />PERMIT# <br />E �' ��2`��`�' <br />