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ELECTRICAL. PERMII" APPLI�ATI�iV <br />CITY OF EVERETT PERMIT SERVECES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />� %� /{ �^ /_ / <br />�-` � �� j� � ' � �f' !�i:��, <br />� <br />PROJECT ADDRESS <br />Cr�(L�(` v <br />Owner <br />/ <br />Mail Address <br />-., — <br />nt Mail Address <br />���GvL .�/,� �'`�. <br />; ,t!�/_" �/ �% //" � /i �i`�i%( �%��, �17� `'�/ �/%- <br />�lectrical Contractor Mail Address <br />r • <br />� �v �� <br />� State Lic nse Number (r quired) ` � <br />������ � <br />Proposed Use of Building <br />� ����'�' -'� <br />Square Footage (If residential new construction, remodel or addition) <br />/T,�%�/�l%,. <br />Number of devices (If low voltage) <br />Description of Work to Be Done: �`/ GT—^ '- l <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />City <br />City <br />/ > G' <br />City <br />� �% '� ) /% l/% /✓� �D ��� <br />State/Zip �-?G, Zf�j�2 Phone <br />i / <br />State/Zip <br />��/7lG-- L �'��w9 <br />State2ip <br />Phone <br />!%5 Zr`/ <br />���ne��� <br />,�(;,���. <br />City of Everett Business License Number (required) <br />'X��%��--� <br />Contract Price of Work <br />,� � �� �� �; _ � � �� - - � z <br />C ntact Person/Contact Number/Email <br />/ �'�i _ c ��, �� <br />�, 0 �- a��/ / <br />/� �� L -�%` ��.��rf %'r �= ��G���"r=� � <br />�H /i- �� f,� a-�`ir���: i(/�-I� f�,C�.� ui� <br />1 hereby certify that l have read and examined this application and know the same fo be true and <br />correcf. All provisions of /aws 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 to <br />violate or cancel the provisions of any other sfate or local law regulating construction or the <br />performance of construction. That 1 am authorized by the owner of this properiy to perform the <br />work for which application is made and I comply with the Siate Contractors Law 18.27 RCW and <br />296.200 WAC. <br />� <br />C� i L/�,/ �,;. I <br />��gnat re <br />REVISED 08/06/2014 <br />%/_ �- /5 -. <br />uate <br />FEE <br />.� � � <br />PERMIT# <br />E W 15( I -o �3 <br />- D`-fSD <br />