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ELECTRIC�►L PERIVIIT 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 />�� z,1 G�%�� �►� �i t/�� .�v��,�� C�f� � v z-� % <br />PROJECT ADDRESS <br />��^r� �c.�,r-�.,,.. �? �� �s���s� ✓�� �d/'��,�s,ti��L� c..�,� ��� ��� ���� �;� <br />Owner Mail Address City State/Zip , Phone <br />���C <br />Tenant <br />�.,-� (�,�i� <br />Electrical Contractor <br />State License Number (required) <br />Mail Address <br />Mail Address <br />City <br />City <br />�' � l� -� l. (1�' (;� l� � � � � k.(!.n. ��--� <br />Proposed Use f Building <br />��b`� <br />Square Footage (If residential new construction, remodel or addition) <br />Z `� � �ti-��� <br />Number of devices (If low voltage) <br />State/Zip <br />State/Zip <br />Phone <br />Phone <br />City of Everett Business License Number (required) <br />� yc�t�v � <br />Contract Price of Work <br />���.� � <br />Contact Person/Contact Number/Email <br />Description of Work to Be Done: ��� � � �-� � '^' � �'� �'- �� " `�'�-� � � � �J C�-!� ✓\ � 1 y �^.I. (, <br />� � w f� �' �. � (�r �c, (�-� � S f � r il P � �' ' � G � C,. r � 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 goveming this type of work will be completed <br />whefher specified herein or not. The granting of a permif does not presume to give auihoriiy 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 />uate <br />REVI SED 08/O6/2014 <br />FEE <br />�� C� <br />PERMIT# <br />E��O�- I���" <br />YSS" <br />