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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 />�� � 3 :� � 7 ' "�vr �-✓' <br />PROJECT ADDRESS <br />� ; tlt <br />w" �u�y�: �..��5 :� I 3=� �i /�v�L /.� ��,.;,���rr �vr� �l��la; y.t�-74a..��8i <br />Owner Mail Address City State/Zip Phone <br />Tenant <br />Mail Address <br />City <br />State/Zip <br />Phone <br />��►�! L�.I.EL T��. ..34f3�1 �� ����bl�L �1/� F u�;.� tr �/1�- � is �l7 i ti1 S�.? S�2 - I?l3C <br />Electrical Contractor Mail Address City StatelZip Phone <br />t�P��L.�Ei �1�.P?t� <br />State License Number (required) <br />Proposed Use of Building <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />�J 6D�—[ <br />City of Everett Business License Number (required) <br />�.3�p `-= � <br />Contract Price of Work <br />P�v�u S��u�us 3�U -L�1-d5"[► <br />�S�GVGNS l��Li,..�! �I ce�v- �� . c �;-►� <br />Contact Person/Contact Number/Email <br />DescriptionofWorktoBeDone: �l�..ST�'lZ,l. «����t rJLITL�'�` j"�r� (r�,y ��c� �OL�L�, <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <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 ordrnances governrng this type of work will be completed <br />whether specified herern or not. The granting of a permit does not presume to give authority to <br />violate or cance/ the provisions of any other state or loca/ law regulating construcfion or the <br />performance of construction. That / am authorized by the owner of this property to perform the <br />work fo� which app/ication is made and / comply with the State Contractors Law 18.27 RCW and <br />296.200.�AC. „ _ <br />! *�C � �•� ' � <br />ature <br />REVISED 08/06/2014 <br />FEE <br />�'� <br />�� �� . <br />PERMIT# <br />E151ZI� <br />