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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 />l �'�a �- �� � � c�c� t �� ' � 1� �� <br />P OJECT ADDRESS , <br />���>�', ;�„\� � � � is�� �.c,� <br />�����"��,� ^' �����-� ;�;`� �"� zv �,:� � � <br />Owner Mail Address City <br />�� � <br />Tenant <br />�� i���� <br />Electrical Contractor <br />r- � r--,. �yr- � <br />_ �A � �i� � `� � �.J <br />M I Address <br />�� � �`.? ��� � �� <br />Mail Address <br />State License Number (required) <br />� � - \�; � <br />Proposed Use of Building <br />Square Footage (If residential new construction, remodel or addition) <br />I �\ � c �,� � ,;0 ���� <br />Number of d vices (If low voltage) <br />, <br />�'i <�: 1 <br />� ' <br />��� � � y 1_ <br />City <br />�_, t;� <br />City <br />5. <br />r- �S � � �.�':� �'\� sa -;.� <br />State/Zip Phone <br />``��'�I `l�-�3yi�` I�� <br />� <br />State/Zip <br />State/Zip <br />Phone <br />Phone <br />City of Everett Business License Number (required) <br />�R �'� <br />���� - <br />Contract Price of Work <br />Contact Person/Contact Number/Email <br />� � `� _�. - <br />Description of Work to Be Done: �i7'1�� � -� � � i ' (. `1'`� ° � "�'``� �-�C. 1 %'� � ► 1 �a �' �.L �, <br />,' � � �'w ���'�� � � <br />FEE <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 L�� �"� <br />I hereby certify that l have read and examined this application and know the same to be true and J <br />correct. All provisions of laws and ordinances governing this type of work will be completed <br />whether specified herein or nof. The granting of a permit does not presume to give authorrty to PERMIT# <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 fhe owner of this properfy to perform the E I(� I I .—� �� <br />work for which application is made and I comply with the State Contractors Law 18.27 RCW and I <br />296.200 WAC. <br /><. .-��'�, ��-"'�� � � � ' � � �^� <• � � <br />' ' Signature Date <br />REVI SED 08/D6/2014 <br />i'' <br />