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ELECTRICAL PERNIIi 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 />"7 C���v � ��' � � <br />PROJECT ADDRESS � <br />Owner <br />Tenant <br />Electrical <br />Cc / 2. �f' Scv�r�� a S a <br />Mail Address <br />Mail Address <br />� I �c /.�s <br />Mail Address <br />�S �!�' Z' �v3 %Kl <br />State License Number (required) <br />c�-/'�/' �r'e Sa �� �- �5 f<l.c.� <br />Proposed Use of Building <br />City <br />City <br />,�`' ST- �U�= ��1, <br />City <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />Description of Work to Be Done: <br />� • �c<.� � <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />State/Zip <br />State/Zip <br />�� <br />State/Zip <br />Phone <br />Phone <br />/ �Z23 3�p �/U3 S'lS� <br />Phone <br />�'��'��`� <br />City of Everett Business License Number (required) <br />Contract Price of Work <br />Contact Person/Contact Number/Email <br />77 2 SO � I" <br />1 hereby certify fhat I have read and examined this application and know the same to be frue 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 authoriiy to <br />violate or cancel the provisions of any other sfate or local law regulating construciion 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 co with the State Contractors Law 18.27 RCW and <br />296.200 WAC. <br />��/� -/5� <br />re <br />REVISED 08/06/2014 <br />FEE <br />1�� <br />, _�- <br />��� <br />PERMIT# <br />E V���— ��� <br />