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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 />+.,�, �`�� i�`�F���S� � L_l� F-'�-� tT F' `��tJL-- 4�/-4`� <br />PROJECT ADDRESS <br />Owner <br />> <br />� ��' <br />Tenant <br />Mail Address <br />�'`l�r��l.,� � C;�'c�S <br />Mail Address <br />City <br />� ���>� -, <br />City <br />State/Zip <br />Phone <br />��'-(��1 Tlts�� (���C��E� <br />State/Zip �. / Phone <br />C� f 2�j� ��� � ��� � <br />�- � r��� � �-��( -� 2 �c�% � <br />Electrical ContrBCtOr Mail Address City State/Zip Phone <br />i��� � E� � ��2� ��— U L-+-�7�5 /� <br />State License Number (required) City of Everett Business License Number (required) <br />_�-�-t �� ( j-=F-'�� �-�.����- ��;�j� ��, � �--���-�- i 7� ��U u <br />Proposed Use of Building Contract Price of Work <br />i � �� � <br />Square Footage (If residential new construction, emodel br addition) <br />Number of devices (If low voltage) <br />�.)li��� � l{��r[ «' '�C>S'I���,� _— ,� <br />Contact Person/Contact Number/Email <br />—)`=�'` L _-�'� ( � • � C� <br />� "� � �� � L � �� ' �� <br />Description of Work to Be Done: �� � -k-�-��lC���,� �.���j , � � � � <br />� <br />�--�C� �`� ( N�' �'� �'' � � --- �-��'f�E.�- <br />CIT�' OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby certify that 1 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 nof presume to give authority to <br />violate or cancel the provisions of any other state or local law regulating construction or the <br />performance of construction. That I am authorized by the owner of this property to perform the <br />work for which application is made and 1 comply with the State Contractors Law 18.27 RCW and <br />296.200 WAC. <br />re <br />REVISED 08/06/2014 <br />r�/�f�� /��� <br />FEE <br />b c� <br />���� ��S <br />PERMIT# <br />E � �j�0 -��� <br />