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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.gov <br />�. � .0 � ( � �t �� � 1� `i l %� 2 />>/'r., r� r_`f: ' � ';� `��,�,.c�J 1 <br />PROJECT ADDRESS <br />�`�,d �� ���1_;L �r �.il,�i ���� ,�, �- 1?,�: 'ii � lY?/�r�?°'i L iG /'" �.L.� ���� �1�; i �/ Z� ii� � � <br />✓ � ' �i., <br />Owner Mail Address City State/Zip Phone <br />Tenant <br />Electrical Contractor <br />State License Number (required) <br />�i HC;/� % 5 � /�s: �=1 lr <� <br />Proposed Use'of Building <br />�. �`.S � ��� z- <br />Mail Address <br />Mail Address <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />City <br />City <br />State/Zip <br />State/Zip <br />Phone <br />Phone <br />City of Everett Business License Number (required) <br />Contract Price of Work <br />Contact Person/Contact Number/Email <br />Description of Work to Be Done: i�F nladr= /a�1N�C� SSA�� r�i �%�/.�(� 1�.; /Nc> ,� 1!=r"' i,k �� Fi/ <br />. i :1 <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certify that l have read and examined this application and know the same to be true and <br />correct. All 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 ofher state or local law 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 1 comply with the State Contractors Law 18.27 RCW and <br />296.200 WAC. <br />REVISED 08/O6/2014 <br />0 <br />FEE <br />�� � � �''� <br />PERMIT# <br />EUVI�C�f�� <br />