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ELECTRICAL PERMIT APPLICATION <br />ClTY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 � <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />, <br />� ,-� <br />l� 2 I 7 - ��'���—s 1�� � ��c� � ti� �� �-c ��-� y �\,�v%-�1 �-� ��� <br />PROJECT ADDRESS � ��/�/� / _ <br />� v l�J <br />'���;�c �� C�c�=���� )r s y� �.�v . l�0 r��� � J� �<�1�C�v��1�'�'�'A <br />Owner Mail Address City State/Zip � Phone <br />, �� � -��ll ���C�l <br />Tenant / <br />Ro�,����\� <br />� <br />Electrical Contractoi <br />Mail Address <br />l--I�L' Gi'V�iC <br />Mail Address <br />,���vl��`'� <br />State License Number <br />- '� <br />�=�� l V\ iC,� L� �Z�-\ ��,'\� <br />Proposed Use of Building <br />� \� <br />Square Footage (If residential new construction, model or � <br />Number of devices (If low voltage) � <br />Description of Work to Be Done: <br />4 <br />City <br />City <br />�U E <br />State/Zip <br />State/Zip <br />Contract Price of Work <br />Contact Person (Plan Review) <br />_ �- V` � V 1 ��1 ( C�"� i�; <br />Phone <br />Phone <br />,r� <br />' � �" � / 1 <br />.�� �� ��. C���E��z��) � t�<<�n,� t�-��� �y ��� � � 1�1 r� �.� � �� C <' X�i c� � -t � ��C <br />� v V�i�c��u I �: �'� FEE <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 ��---�— <br />Z� <br />! 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 type of work will be completed <br />whether specified herein or not. The granting of a permit does not presume to give authority to PERMIT# <br />violate or cance,�'the provisions of any other stafe or local law regulating construction or the r <br />performance of construction. That 1 am aufhorized by the owner of this property to perform the t(�-� �J� .� ���� <br />work for whic application is made and I comply with the State Contractors Law 18.27 RCW and <br />296.200 W�. � <br />r �i I <br />�� L� <br />iqnature <br />Date <br />_ 2.� � __ � Cr� 1 L <br />�-� <br />