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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 />� � � S�o�- ,��-� <br />PROJECT ADDRESS <br />� <br />�%,�l � /� .2J .�cti'�c'In.Sco�.,� 3�'� sF(�;�u2e �-,,�' C�v�'�'T7` �£�Z � <br />Owner Mail Address City State/Zip Phone <br />Tenant <br />S �r -t c: i �� /c <br />Electrical Contractor <br />Mail Address <br />23vu z <br />Mail Address <br />,�5�� �,�� �� 7� � Lr <br />State License Number (required) <br />Proposed Use of Building <br />� j��,�c � j a F; • <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 />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />City <br />City <br />State/Zip <br />State/Zip <br />Phone <br />6y"i:�C� <br />Phone <br />�I�O� � � � �5 <br />City of Everett Business License um er (required) <br />Contract Price of Work (�ZS� �y�— ���3 0 <br />✓c-�f SA /Gc9/L5 <br />��� ` L�C-i i��G (.c1� ��i�'G� , l' ck� <br />� <br />Contact Person/Contact Number Email <br />1 hereby certify that / have read and examined this application and know the same to be true and <br />correct Al/ provisions of /aws and ordinances governing this type of work will be comp/eted <br />whether specified herein or not The granting of a permit does not pr�sume to give authority to <br />violate or cancel the provisions of any other state or local law regu/ating construction or the <br />performance of construction. That I am authorized by the owner of this property to perform the <br />work for which application is made and / comply with the State Contractors Law 98.27 RCW and <br />296.200 WAC. <br />� <br />REVISED 08/ON2014 <br />t3 <br />FEE <br />-�r Q�l <br />J <br />PERMIT# <br />E��o�- ��� <br />