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� <br />ELECTRICAL <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.gov <br />� � I� I � v� . <br />�GvY � �� ��� �ai� ,��c ��� <br />�� i �1 <br />PROJECT ADDRESS <br />� <br />t�� j �. <br />� �',� �'� L,l�'�, � � L�i�tL� I f .�:+'t�(�� � �1�" � <br />owne� <br />� � �r- , � <br />� � �.� ���� <br />Tenant <br />� <br />I���� �,� <br />Elec rical Contra tor <br />Mait Address <br />.��+,� <br />Mail Address <br />City <br />l�tt �i'�� ���� <br />City <br />1 `�G��U�iFiU� L�U "�GG' <br />Mail Address <br />�:�. i �,��'� � �� � � U <br />State License Number (requireda <br />� <br />������� �j����`�- <br />Proposed Use �f Building <br />(�`�"��'� <br />Square Footage (If residen6al new construction, remodel or addition) <br />�` <br />Number of devices (If low voltage) <br />Description of Work to Be Done: <br />�k���� i��� <br />�1�k��i ����� <br />L' 1,� 1 � 1� � � <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />�� ����l� ���� <br />� <br />State2ip <br />V v�E � <br />State/Zip <br />��.C� <br />� <br />State2ip <br />Phone <br />Ph n <br />�> '��. <br />� ��.-r-�--�--��� <br />Phone <br />�������� <br />City af Everett Business License Number (required) <br />!� ,�� _,� �.� <br />Contract Price of Work <br />i � <br />� <br />.�C�, ��-� ti���� � C ���� �,�� � -��� - �1��'�' <br />Contact PersonlC q�act N mbe Email <br />� Lt,� �,��li �,�' vt�'�1 t��t.l VvC��'�'� <br />.� ejd l'��i1���, U�''''' <br />r�4-� o��� ��-�V��h� <br />t t�-� � �'v u� +�-L �� <br />I hereby certify that 1 have read and examined thrs application and know the same to be true and <br />correct. AI! provrsions of laws and ordinances goveming this type of work will be completed <br />whether specifred herein or not. The granting of a permit does not presume to give authority to <br />viotate or cancel the provisions of any other state or /ocal taw regu/ating construction or the <br />performance of construction. That l am authorized by the owner of this property to perform the <br />work for which appfication is made and I comply with the Sfate Contractors Law 18.27 RCW and <br />296:�200 V1�A C. <br />;��: � �� , i��(,� <br />nature <br />REVISED 08N6l2014 <br />FEE <br />� ��� y <br />� <br />PERMIT# <br />E l� (�C� - l�l� <br />� <br />