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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 />2��� �� C� (.�- �� 1'� L'�U� �--liC���'� <br />PROJECT ADDRESS <br />_ <br />� �� � �� � <br />Owner <br />Tenant <br />Electrical Contractor <br />Mail Address <br />Mail Address <br />���o� <br />Mail Address <br />��.C�-I;Z� �� �c� 71 !� �_ <br />State License Number (required) . <br />��-v_� �P ����5� � <br />Proposed Use of ilding <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>1���� <br />��� (� � Cl�L1� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />C ity <br />City <br />City <br />', �. r <br />State/Zip <br />State/Zip <br />Phone <br />Phone <br />/r� � �Z`��� �Z� � T �t� <br />State/Zip Phone <br />� ������ <br />City of Everett Business License Number (required) <br />4� � (; ���" <br />Contract Price of Work <br />4 1 C� I J`� �� <br />Contact Person/Contact Number/Email <br />� <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 fype of work will be completed <br />whether specified herein or not. The granting of a permit does not presume to give authority fo <br />violate or cancel the provisions of any other state or local law regulating construction or fhe <br />performance of construction. That 1 am authorized by the owner of this property to perform fhe <br />worfc far- which application is made and I comply with the Stafe Contractors Law 18.27 RCW and <br />29� 00 WAC. <br />re <br />REVISED 08/06/2014 <br />FEE <br />�oO� <br />PERMIT# <br />E c`f�o-- r�S� <br />