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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 />� C���� z 1�.:��',-��-,r���, <br />PROJECT ADDRESS <br />�t'�c�4���. <br />3(� -- (o I D <br />��'v(�-'-�� ��'i c� ZC� Z L�. ��C:it� � ' �r., % .�a;I If'�i (. �J�i f ���� (s-7 3 ( <br />Owner Mail Address City State/Zip Phone <br />Tenant Mail Address City State/Zip Phone <br />� �if-i C, <br />Q��I�f����1y Q�u,�s�ir��i' Nru�i�r�-� �.�y7-A Su�� '�i�k ���>r��-� � e�,fl�,'�_j��l ���'� 7��0- 55"s'�� z <br />Electrical Contractor Mail Address City State/Zip Phone <br />����-H`rv:��C�`t7�v � <br />State License Number (required) <br />�� <br />-.ilYlQ�� � Lii`�11��/ �Sl���'1C� <br />Proposed se of Building <br />����x 15�.�� C �t- <br />Square ootage (If residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />o �� ��� <br />City of Everett Business License Number (required) <br />� � Z�./� , r��� <br />Contract Price of Work <br />��c'iL—' ��`L -`�SSS—ZCvL�S <br />Contact Person/Contact Number/Email <br />Description of Work to Be Done: � ��(! .�' rv�G�'�.c T (,�:>t c�- �� t� � �'.� �1.1.( YICi� .i, <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby certify that I 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 other state or local law regulating construction or the <br />performance of construction. That I am authorized by fhe 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 />Signature <br />REVISED 08/O6/2074 <br />Date <br />FEE <br />JO�� <br />PERMIT# <br />E��J�J����b� <br />