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ELECTRICAL PERMIT APPL.I�AI"IOIV <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 />t l b'Z l� �T►�►'1 � lZ C <br />PROJECT ADDRESS <br />� � �c� �-�I s �m�� <br />Owner Mail Address City State/Zip Phone <br />Tenant <br />Maii Address <br />City <br />State/Zip <br />Phone <br />1� o u� �S Gfl »s�', 1 N� l b 3� �v � i bq i-h �-�- S�n¢ l�nc u� t� ��6155 ?� �o-�?�i, 6� t S <br />Electrical Contractor Mail Address City State2ip Phone <br />� c� w�5 �_ � � 2-3 )2 <br />State License Num r (required) <br />� o�� <br />Proposed Use of Building <br />I/11'1 k,YlO'VJ � <br />Square Footage (If residential new construction, remodel or addition) <br />� �=1 <br />Number of devices (If low voltage) <br />Description of Work to Be Done: <br />W � 'n�L�l� inil�(i <br />Cify of Everett Business License Number (required) <br />�1 �� <br />Contract Price of Work �}� <br />201v � ?�i`�—lo� 1S r 1m,�ow2S � � <br />, � 1'1S�" <br />Contact Person/Contact umber/Email <br />i�l�'�.�' o��1 �p ►�vl� �'-b 2�a �rn Q S o�l�, n�� <br />r)c�r� Pg'M.e� cr,n� mc�� <br />��r��ir �f +�e o r�r�2.� � <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby certify fhat I have read and examined this application and know the same to be true and <br />correct. A!I 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 />violafe or cancel th provisions of any other sfate or /ocal law regulating construciion or fhe <br />performance on truction. That I am authorized by the owner of this property to perform the <br />work for ch app! ation is made an�{ comply with the Stafe Contractors Law 18.27 RCW and <br />296.2 WAC. �_ i% / <br />�a I �� l� �s <br />REVISED 08/O6/2014 <br />FEE <br />� � �,� <br />�� <br />PERMIT# <br />E f�n� 9 �� �� �� � �� � <br />