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ELECT ICAL <br />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 />� <br />,� e � � �;�, �;, <br />PROJECT ADDRESS <br />Owner <br />��%/ /j %(� .� V ��-�1 <br />Tenant <br />�/��'��� /_ <br />Mail Address <br />Mail Address <br />City <br />City <br /><So 3 5 %v��� �� <br />Electrical Contractor Mail Address <br />���/� f���� <br />State License Number (required) <br />���/G �- <br />Piuposed Usr of Riiilcli�-�g <br />3� � <br />Square Footage (If residential new construction, remodel or addition) <br />`�,�'�o �� <br />Number of devices (If low voltage) <br />City <br />Description of Work to Be Done: <br />�.1 �s ���� � �.T��es <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 />�/�ls � 7 y ?S7� <br />Phone <br />City of Everett Business License Number (required) <br />�ontracl NncA or 'v�orl�. <br />Contact Person/Contact Number/Emaii <br />l hereby certify that I have read and examined this application and know the same to be irue and <br />correct. All provisions of laws and ordinances govemrng ihis type of work will be complefed <br />whether specified herein or not. The granting of a permit does nof presume to give authorify to <br />violate or cancel the provisions of any other state or local law regulating construcfion or fhe <br />performance of construction. Thaf I am authorized by fhe owner of this property to perform the <br />work for which applrcafion is rnade and l comply with the State Contracfors Law 18.27 RCW and <br />296.200 _ <br />./ �� i��� /-/� �� <br />REVISED 08/06/2014 <br />FEE <br />�� � �� <br />PERMIT# <br />E 150 i - �� <br />