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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 />I��� <br />�� i �� �c�c: � -�� � <br />PROJECT ADDRESS <br />i ��-�c;�l� �", l I�;� LL� <br />Owner <br />�� V <br />Mail Address <br />City <br />State/Zip <br />Phone <br />�' � C! �U� , %fi'�' <br />t3�'iiV�ct� Y�p.. 13i5 i�ac,�rc .�,,�e I;er� 1 <br />Tenant Mail Address City State/Zip Phone <br />��'�1 K��;-It.k, �;�1 C`�:�1;� (��. d��x 3z <br />Electrical Con ctor Mail Address <br />���M �EF� �� �Q- <br />State License Number (required) <br />Proposed Use of Building <br />Square Footage (If residential new construction, remodel or addition) <br />� <br />Number of devices (If low voltage) <br />;JI�IC„�I �/�;�vi- �/�C��3J /ZJ��'Ll'��/.J <br />City State/Zip Phone <br />City of Everett Business License Number (required) <br />� ` �� <br />Contract Price of Work <br />�E�Q►�w .�cei�e� `i2�-f�21 �lZt3 <br />Contact erson/Contact Number/Email <br />Description of Work to Be Done: �):5 �C [� 3 / v����"m0 `J�q (-S <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certify that I have read and examined this application and know the same to be frue 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 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 I comply with the State Contractors Law 18.27 RCW and <br />296.200 WAC. <br />' �s. —.. <br />G <br />REVISED OS/06/2014 <br />Z <br />FEE <br />1 <br />� 5 Oc� <br />PERMIT# <br />E.�iSo�-- �Z.0 <br />