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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 />,� � J <br />�`1�0� :.:5-i.�o �1��/c�L� ��f� � Ct�/� <br />PROJECT ADDRESS <br />�'JLrZ�T7� lii�.[7/i �< < � �a z s� r � F;Z,�T-,�� �� `���y Cv�.��z�� (� � �Z �s-- �; �: r � <br />Owner Maif Address City State/Zip Phone <br />���-��r7- � o Cv �`r� l�(.� a,'y� / l/o <br />Tenant Mail Address <br />>c ce r'�c �,.4 r.r� ,�,/...� c� Z i � ��3 � <br />Electric Contractor Mail Address <br />JS� c.� Tff � i ,� � � /� % <br />State License Number (required) <br />�STr"-7ct�Z�l�/e <br />Proposed Use of Building <br />i : <br />� <br />,� q�� <br />Square Footage (If residential new construction, remodel or addition) <br />� /� <br />Number of devices (If low voltage) <br />Description of Work to Be Done: <br />��%it�J �f'�G% �L/i`t / <br />City � State/Zip <br />��✓; GJ�I `/''� s Z, <br />City State/Zip <br />Phone <br />Phone <br />'��-S��Z, <br />City�f Everett Business License Number (required) <br />/`'If>t�U•�!L% <br />Contract Price of Work <br />L e-f�2 � S i'�5 r? L r+a 5 iZe ���7�'--7�'G � <br />C�2 �s L- 5.��,�Tc �,� �. . �� w�. <br />Contact Person/Contact Number/Email <br />� �,r,� i-�- .� � � /.� � X �S T� �' <br />. � <br />,�'7��- /� �S � �� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certify that / have read and examined this application and know the same to be true and <br />correct All provisions of /aws and ordinances governing this type of work wiN be completed <br />whether specified herein or not. The granting of a permit does not presume to give authority to <br />vio/ate or cancel the provisions of any other state or /ocal law regulating construction or the <br />performance of construction. That / am �thorized by the owner of this prope�ty to perform the <br />work for which application is made ! comp/y with the State Contractors Law 18.27 RCW and <br />296.200 WAC. <br />re <br />REVISED 08/06/2014 <br />FEE <br />i���(�-� <br />PERMIT# <br />E ����� ���� <br />