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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 />1 <br />� � �i � �„ �.�' �, � ��� �J �(2.�. � tii � <br />PROJECT ADDRESS <br />Owner <br />Tenant <br />C y <br />� �� � �v � ��� � �� 1 � ��,� � �s f � t P �, k� ,� � � <br />Mail Address City State/Zip <br />���L,� <br />Mail Address <br />City <br />State/Zip <br />Phone <br />��.r� % � ��v` <br />Electrical Contractor Mail Address City State/Zip Phone <br />State License Number (required) <br />,- � 1,�. � � <br />_ --- <br />���� <br />:.:� �ti � � � �� �-�. S <br />Proposed Use of Building <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 />�-�--� .-�-�,..�� ���� �; �� �_�. � <br />�v���`������-�� C�' <br />�� �� � �.� ' � L � � �. � <br />!�`%<�-� <br />City of Everett Business License Number (required) <br />Contract Price of Work <br />Contact PersonlContact Number/Email <br />�.�� �-� �� C,.. I -�.v E�.-� � 0 ✓� S�Cd(r�c -� � � �S <br />S V � �U��, � <br />ht'�i"'i � <br />` i <br />� v����:t_`` ( CiY�(S� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />f , <br />C i�, .��.. ;'l �.� '�L: � �" �� �L` G%� <br />, � ].� /' <br />�i �'� -� j .,_L.-7 C� C � � � � �� � <br />I hereby certify that 1 have read and examined this application and know the same to be true and <br />correct. All provisions of laws and ordinances goveming this type of work will be completed <br />whether specified herein or not. The granting of a permit does not presume to give authoriiy to <br />violate or cancel the provisions of any other state or local law regulating construction or the <br />performance of construction. Thet I am authorized by the owner of this property to perform the <br />work for which application is made and 1 comply with the State Confractors Law 18.27 RCW and <br />296.200 WAC. <br />REVISED 08/06/2014 <br />FEE <br />�� � �i <br />(� �F� ..�- <br />PERMIT# <br />E �.� � �� �'��� <br />