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� <br />ELECT ICAL 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 />� �O� ' .� `�j' t,� 5 �7. S �--�', <br />PROJECT ADDRESS <br />���c r-� �����,� .� S��-�h � � �� ��-���� �.,� �a au3 3�� 3�1�3G� <br />Owner Mail Address City State/Zip Phone <br />Tenant <br />Mail Address <br />C ity <br />State/Zip <br />Phone <br />UU�RL��-C �i.z-�7'�,� V �� (3��n Ll��° �C-G�-Lu-tiZ � yc�vCs �? �-'�= 7 i3 �(vGrS� <br />ElectriCal Contractor Mail Address City State/Zip Phone <br />Uv ���Lt � �l 7 �� <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 />�,�c f i �� �� <br />City o verett Business License Number (required) <br />;, <br />�� � �� <br />� <br />Contract Price of Work <br />� v�-� � � 7 `9 3 _ ��1� l <br />Contact Person/Contact Number/Email <br />Description of Work to Be Done: }"�.Q� �/ � L�l' � �`n �/� <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 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 authority to <br />violate or cancel the provisions of any other state or loca! 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 applicafion is made and I comply with the State Contractors Law 18.27 RCW and <br />296.200 WAC. <br />�S�i�%l5 <br />ature <br />REVISED 08/O6/2014 <br />FEE <br />� � L> <br />U <br />PERMIT# <br />E�5o5--0�� <br />