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� <br />ELECTRICAL PERMIT APP ICATION <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 />"� � 0 � (� � i��S t�� � <br />PROJECT ADDRESS <br />C F"i'I� ( S�)/ 11�� y� (� �� 7j � c.� � D�c �-� l�t U� f�,' �-� �� G��- `� �� �� ��( z 5- s�8 Y <br />Owner Mail Address City State/Zip Phone <br />Tenant <br />Mail Address <br />City <br />State/Zip <br />Phone <br />i-( (�-Vc �-i� l=c-FC itL i C�-� � (�l �(���6�`{ N N fhle N S tl U �`�-� C.( /� i.` C.1.R `� Y' � 3� Z O i`f3� -�! <br />Electrical Contractor Mail Address City State/Zip Phone <br />�-f ��� �� �� s��� c� �z <br />State License Number (required) <br />t�-c'S � (k=� � t ��-� <br />Proposed Use of Building <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />�Z�S��S"� <br />City of Everett Business License Number (required) <br />Contract Price of Work <br />{i c�fJ��Z. r�����--�^— 2_U b`fs t����i\ <br />Contact Person/Contact Number/Email <br />�-1 �Q'&�-V � Sr z7. G< <i2 � L v.J ,�� C;, M t'� <br />, zz� .; <br />Description of Work to Be Done: �(j1�5 � U f�' �� � �'v � U �S w�'!'- K- �/�"17 ��� Z U� <<�U i( <br />�— <br />cJ Z�t U�� Z v h- ��s"�-�- �� �� <br />CITY OF EVERETT LOCAL SALES TAX CODE 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 goveming 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 />pertormance 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 State Contractors Law 98.27 RCW and <br />296.200 WAC. <br />nature <br />REVISED 08/06/2014 <br />�'J � (�- f � <br />Date <br />FEE <br />���� <br />PERMIT# <br />E(5OS-�Z� <br />LC�,M <br />