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• � <br />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 />�C �c�'�c1'viP �f ' Q , ��/�i�I <br />PROJECT ADDRESS <br />Owner <br />Tenant <br />��� C�u�� <br />e {� 4Q�� <br />Mail Address <br />Mail Address <br />Electrical Contractor Mail Address <br />City <br />City <br />City <br />��� C'� tr �3� �� �� o L o ��?,atlo <br />State License Number (required) <br />�� � <br />P oposed Use of Building <br />� �����. . <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />Description of Work to Be Done <br />�,,���� U�(,� �10JSC <br />� � ����, 3 <br />SNate Zip <br />State/Zip <br />���-a o�.� <br />Phone <br />Phone <br />��t � �i,��c,/ ��� ��l — <br />State/Zip <br />Phone <br />i n ,�C�'r� � <br />City of Evere Business License Number (required) <br />� ��, U� <br />Contract Price of Work <br />i�' ��c �j �'� �'�a � �� <br />C ntact Person/Contact Number/Email <br />� E� �7 � � k�T� <br />�✓���� �.- ��� l� �� � h�--� I . <br />(.� �L'V'1 <br />��' �+r�,✓�'� �- �, � � 1�- � � <br />� � °'`l.� �_�i � �� ��� �p C� . <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerfify thaf I have read and examined this applicatron and know the same to be true and <br />correcf. All provisions of laws and ordinances governing this fype of work will be completed <br />whether 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 I am authorized by the owner of this property to perform the <br />work for which application is made and l comply with the State Contractors Law 18.27 RCW and <br />296.200 WAC. <br />i��°���- ,���-��.��,___ �-2� � r � <br />Signature <br />REVISED 08/O6/2014 <br />FEE <br />� �j�� o0 <br />PERMIT# <br />E � � D3—� �� <br />