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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 />�'j � � �. (� L lc� f2 �- l;".i� <br />PROJECT ADDRESS <br />4Z� 2����721�C <br />S i r-� -�.�/�,-�e r��i=. C�%N � �'�;z �.�.e;.�rcvZ r�-�� rv �;� 9 f�-��l <br />Owner Mail Address City State/Zip Phone <br />Tenant <br />�'-�`���i <br />Electrical Contrac <br />Mail Address <br />r U_c raL( c e� iti�c. 3a <br />Mail Address <br />/�-f � Cs ii� � c c; C 31J J <br />State License Number (required) <br />J ���- <br />Proposed Use of Building <br />�� �� � <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />C ity <br />State/Zip <br />Phone <br />F� i,5�� t_�! �I�t °�' �.3C1 J �{.2:� �� �'�{��c <br />City <br />State/Zip <br />Phone <br />�% 3� 3Yc <br />City of Everett Business License Number (required) <br />Contract Price of Work <br />Contact Person/Contact Number/Ernail <br />Description of Work to Be Done: L'e�%�2� (`�!: %%�ccC.['� �-=- U C(k �� �� f''z'` !��"f' <br />i o a�tt�t t' G-� � i� �� N i►=tl � F Gt� J �=.� <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 governing 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 />performance of construction. That 1 am aufhorized 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 />REVI SED 08/06/2014 <br />— �{ — <br />Date <br />FEE <br />I C�� - � <br />PERMIT# <br />E f �� Di -GC �� <br />