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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 />°' ���c�`� �� � �� �i �i 3 � 3�� t �'���.r� � � �,C�( <br />PROJECT ADDRESS <br />Tenant <br />Mail Address <br />City <br />State/Zip <br />Phone <br />'�A"'.t'(����.� \i`�1�'�` ���� ✓� .7�Vy�1 1 �� C J 1 /V`'I �'!(1�r� �n �._ �(.. 1 1 S \'t'�K Ci :S �� i�C �� N��.CI � �� �� <br />EleCtrical COntraCtor Mail Address City StatelZip Phone <br />.. n r� <br />��-�� r fi s1��c�-r <br />State License Number (required) <br />�l_._�j; 4�Z�'�� ���, � <br />Proposed Use of Building <br />Square Footage (If residential new construction, remodel or addition) <br />�������C C� <br />City of Everett Business License Number (required) <br />r } �r'> <br />Contract Price of Work <br />' ;��4��r� �.���: �'�t5 •- ��'�,k-� <br />Contact Person/Contact Number/Email <br />Number of devices (If low voltage) <br />,� j �., i..,c� � <br />Description of Work to Be Done: �,` �\�C ���' ��� z--�� �'�" <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 frue and <br />correct. AU 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 />violate or cancel the provisions of any other state or local /aw regulating construction or the <br />performance of construction. That 1 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 />� <br />nature <br />REVISED 08/O6/2014 <br />����,_.- 3 _�,c,� <br />FEE <br />� � �C.� <br />PERMIT# <br />E���4� - D2--� <br />�� <br />