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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.gov <br />� � 1 � r'� � �������.� � ��� <br />PROJECT ADDRESS <br />� ���� <br />Owner <br />� � � -� <br />Mail Address <br />City <br />State/Zin <br />Phone <br />- - Jt� l `�'� <br />Tenant Mail Address City State/Zfo �. � P�ho�e� <br />C7.- <br />�� �-���� �c���� , �� � �`�,t���c r.��.� �,�� 171 i �.r-�L 1 `-� �-�, S� �1t.� ���'a�i .) � �i ���� � <br />Electrical'Co ntracto r <br />Address <br />� i� c� �t'tit�r�E � � � � 1'��� <br />Stat�e Number (required) <br />��� <br />Proposed Use of Building <br />l�Jo <br />re Footage (If residential new construction, remodel or addition) <br />�'P �� <br />Num�devices (If low voltage) <br />Qescription of Work to Be Done: <br />S <br />Citv <br />State2i� <br />Phone <br />�5�1�'i�"3 <br />City of Everett Business License Number (requirec+) <br />,a � D <br />� j ' ),'J <br />Contract Price of Work <br />c���, �'J :� �.���. - ������ � . <�ti, <br />Contact Person/Contact Number/Email <br />FEE <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 ���` �� <br />_� <br />! hereby certify thaf 1 have read and examined fhis application and know the same to be frue and <br />correct. Al! provisions of laws and ordinances goveming this type of work will be completed <br />whether speci�ed herern or not. The granting of a permit does not presume to give authority fo PERMIT# <br />violate or cancel the provisions any other state or local /aw regulating construction or the <br />performance o�' construction. Th�f I am auihoriz d by the owner of this pmperty to perform the E����� ��,� <br />work for which application is made and l comply ith the State Contractors Law 18.27 RCW and <br />296.200 WA� <br />Date <br />