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ELECT CAL PERMIT APP CATION <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 />�� �. � �--� � - /� � <br />� (� iC�C,i , < <=- �" "- � iJ ��� f'z �`� � („l,,) �'�y Z � t U � <br />� <br />PROJECT ADDRESS <br />�tZ� �: , Cxi' �'lC.i. `�(; � • <br />� ���ey i <br />Owner Mail Address City <br />Tenant <br />Mail Address <br />C ity <br />State/Zip <br />State/Zip <br />Phone <br />Phone <br />V��'� � �c.�.K':C� (�� ��� �ir�-f (���- _�t��-1C_ c��� i�;��-�, �c�, - �ljG; �57� � <br />ElectriCal ContraCto� Mail Address City State/Zip Phone <br />v,�Cj�cC--a- 5�! Z fw V' <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 voitage) <br />Description of Work to Be Done: <br />��� <br />C�,�i�;,r•14�c�C�-� �0� <br />Ca <br />✓ � <br />�(:-i ��:.� o -�- �� � � <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />t� �� � `i �t � <br />City of Everett Business License Number (required) <br />� Z � �" �,-� <br />Contract Price of Work <br />Contact Person/Contact Number/Email <br />,� C` �.;�c.._ <br />� <br />1.c�-�C-� . �� %ti"�C�1 i�-�-v� <br />1 hereby cerfify 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 />whether specified herein or not. The granting of a permrt does not presume to give authority to <br />violate or cancel the provisions of any other state or Iocal law regulating construction or the <br />performance of construction. Thaf I 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 18.27 RCW and <br />296.200 WAC. , , `� ,. <br />�/ .�/��y <br />REVISED 08/O6/2014 <br />FEE <br />� � <br />� � <br />PERMIT# <br />Er�a� ' <br />- ��� <br />