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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 ,��1rti1 �� 1 ���L <br />PROJECT ADDRESS <br />�!_��i- �,l� .�f�v' <br />Owner Mail Address City State/Zip Phone <br />Tenant <br />Mail Address <br />City <br />State/Zip <br />Phone <br />'/` �� %�'.�,��? <br />` �C�=� IJ ;�ti,1 ��a�u ; c cf � i�' ic_ � ; �-.v< <�+:2 �c� � 5 � -cJ� <br />Electrical Contractor M il F�ddress City State/Zip � Phone <br />� S� �.7C c'vio!�fh� ��;2 ��S-S ('y�c��j cr <br />;(`�l�i� f- � �� � �l � <br />State License Number (required) <br />+�/�1/�('� C��6 �j ��r �f C i�l,��- <br />Proposed Use of Building�— <br />��� <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />� �l1 % <br />City of Everett Business License Number (required) <br />/ /C� � '``� � <br />Contract Price of Work <br />�'/aT � .� �l�;�ff ���5 �J O.S' � � `'i . I� <br />�tact Person/Contact Number/Email <br />Description of Work to Be Done: {�f L�.'1� C'�U j ,�y/ /,�.7�- �%Cr' �'. � C� i✓Z i�;`1 �-- �/�(%jC(�� <br />riF��„ '�� �� iJi�'� ,�_L,cJ ��� i, � �XL . <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby cerfify that 1 have read and examined this application and know the same fo 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 constructioq . That 1 am authorized by the owner of this property to perform the <br />work for which applicat�c7'is made and I comply with the State Contractors Law 18.27 RCW and <br />296.200 WAC. , ,r----� <br />/ l'' <br />/ <br />�, � ../,. <br />Sign�tu�e � <br />i_ r � <br />REVISED 08/O6/2014 <br />`��S - iS_. <br />FEE <br />���w �� <br />PERMIT# <br />E���-��� <br />7 <br />