Laserfiche WebLink
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.gov <br />" � <br />j r___ � � <br />',�(`�° �, /° r�� J y �' � 's'�(': �' i �'.� - <br />PROJECT ADDRESS <br />�f'��"•�\-�i <br />� <br />Owner <br />Tenant <br />c. <br />1.--� `�Z=� l� <br />I Address <br />0 <br />7'�� <�:C�! h�°�� <br />Mail Address <br />G'; �)� ��t,�:;K �%t , 1,.�, i���.C'�; <br />a <br />City State/Zip <br />� r;� �„l—, <br />' .l � � i.�� l� �i <br />City State/Zip <br />Phone <br />��.s��s�j- %I( z, <br />Phone <br />�` t/9 n // / f <br />�'I �F s�/r //r.�.��d�`:.���r=i./�� �- / (f� A.iY:�� ��� 1�/���r jt�'ti.. G"�°�i �'J � � �. .>����7f,i:-! ��� <br />EleCtriCal Cont�aCtOr Mail Address City State/Zip Phone <br />�, ,�,: , 7 <br />7��./' �, ,%1— %� L�� �`;� t'1 i <br />State License Number (required) <br />� r <br />o'�:��,/,��.-�'°'r�/f:ai �� <br />Proposed Use of Building <br />� � 7---� -�i �:. <br />Squ re Footage (If residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />Description of Work to Be Done: <br />L�.'.� �, i <br />� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />� �� ���. <br />J <br />City o Everett Business License Number (required) <br />�`� �-�' ' �✓ <br />l <br />ontract Price of ork /� <br />C r'' . `K - <br />_ jr'.; � ..u!� . �- "i,- � - Sc � U � _`;� ' / � _�. <br />�e�/�'�ifr,eG��v►r�'�E���' �Q )> ec�� <br />Contact Person/Contact Number/Email <br />c�,!. v'=<. `.a� �,�>"r,Y < < ���f.�f�, <br />� <br />1 hereby certify that I 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 permrt 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 constn�ction. That I 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 />REVISED 08/06/2014 <br />. <br />, �'�/ �?,�- <br />FEE <br />�D � <br />PERMIT# <br />E ���� �(��j <br />