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� � <br />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/ / � <br />l �'-� I/�C ��t f��. �'(/"'�- <br />PROJECT ADDRESS <br />l�,r� c� �+�'. � �S %� � �'�jc�t.�- �v'��t..- �f��=� L��� �'� "7l� - y'�I�� <br />Owner Mail Address City State/Zip Phone <br />Tenant <br />��� ��� � <br />Electrical Contractor <br />Mail Address <br />Mail Address <br />--�►� t-� c� v�.s rsz c� � <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 />City <br />City <br />State/Zip <br />�,� �� �� z�� <br />State/Zip <br />Phone <br />�-f7� �5-�(� o� <br />Phone <br />� � ��Q � <br />City of Everett Business License Number (required) <br />���' i <br />Contract Price of Work <br />_?,�,c��� ��� �'�,3 -- ��7 e�� <br />Contact Person/Contact Number/Email <br />Description of Work to Be Done: 1 `�I iJ( �`�`� "�" � ��'"`�"-� `� � ���'� `"��'"� ��� °�"�L''�� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certify that ! 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 not. The granting of a permit does nof presume to give authority to <br />violate or cancel the provisions of any other state or local law regulating construction or the <br />performance of construction. That I am authorized by the owner of this properfy to perform the <br />work for which application rs made and I comply with the State Contractors Law 18.27 RCW and <br />296.200 WA C. _ <br />r <br />U� � <br />C > ��=�/.� <br />Signatu <br />REVISED 08/06/2014 <br />FEE <br />���� <br />PERMIT# <br />E ���3-D�� <br />