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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 />�.� 71 l V�� ��U �� � ,� <br />PROJECT ADDRESS <br />�� v V� ��'1 r� C� E�i���C i�f <br />Tenant <br />,.� <br />Electrical <br />Mail Address <br />Mail Address <br />� �1�-����<< t�i�5 � 7��1 <br />C�' iJ tL� c � `l�' �, % <br />State License Number (required) <br />�� <br />roposed Use of Building <br />Mail Address <br />City <br />City <br />�"�v� ,��� Lu <br />C ity <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />� � � � � �� I � .� �J �����% <br />State/Zip <br />State/Zip <br />_�'f'Pv� ��;� ��U �- `1� ��. <br />State/Zip <br />Phone <br />Phone <br />LI "L S. <br />-3�"�� <br />Phone <br />i �� (J�Qce s 5 <br />City of Everett usiness License Number (required) <br />Contract Price of Work <br />Contact Person/Contact Number/Email <br />i� � / <br />Description of Work to Be Done: �(J /'�'�� � L�i �' ��� �`��JL�V �G� �<� j/ti �J �' __ <br />��c �,i i �� � �� �,�1_'1� c� � � <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certify that I have read and examined this applicafion and know the same to be true and <br />correct. All provisions of laws and ordinances governing this fype 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 sfate or local !aw regulating construciion or the <br />performance of construction. That I am authorized by the owner of this prope�ty to perform fhe <br />work for which application is made and 1 comply with the State Contractors Law 18.27 RCW and <br />296.200 WAC. <br />nature <br />REVISED 08/06/2014 <br />l�-iZ.l�-1 <br />uate <br />FEE <br />� / "O� <br />PERMIT# <br />E f�l�-��� <br />