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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 />� SC� ����c� �� � w u�l <br />PROJECT ADDRESS <br />Owner <br />Tenant <br />('l�v,rl � ooa.� <br />Electrical Contractor <br />Mail Address City <br />� ��,n.�, w � �, F�-��-k <br />Mail Addre City <br />� �I ��,s h � � kXl �-rc rJ �- � I �/-e �-r► �' <br />Mail Address � City <br />Ec, c����N�=q,� C'C <br />State License Number (required) <br />C��n�trc���. �,�-�►; � <br />Proposed Use of Building <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />State/Zip <br />JE lU, <br />State/Zip <br />State/Zip <br />Phone <br />Phone <br />s� -�7a-���,� <br />Phone <br />�� �U � <br />City of Everett Business License Number (required) <br />� 5, 5�c� <br />Contract Price of Work <br />..���� ��"�tl 1 f%r't�'"r Z���% J j�Pli �'�,,`'-�l?c°;;'F r°.i *' �_r �a.. <br />\ Contact Person/Contact u ber/Ema`ij, u� � <br />Description of Work to Be Done: I(� S�`� �.�n U� l/I ��CA �L�"S �l� � 1�'l � S C QU ��� <br />C�YI,h-e-e��� C.V�,� _ <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I 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 />whefher specified herein or not. The granting of a permit does not 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 1 am authorized by the owner of this property to perform the <br />work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br />296.200 WAC. <br />� <br />REVISED 08/O6/1014 <br />�5 �a �, �ao�� <br />Date <br />FEE <br />� l�� �� <br />PERMIT# <br />E d���— I� <br />