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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 />�r,�f" ,�n'c.5�r�� �� <br />� _, ' <br />f �„�:1� % �/ .�`T�- � �'-� °''�- � <br />. <br />PROJECT ADDRESS <br />r � <br />� e� �F L�G��� � �3�?.�=�= � �.�� ��. �:;�.� � ���- �3�"z� i <br />Owner Mail Address City State/Zip Phone <br />�y��Lv� ✓'�5 �'a-�3W � <br />Tenant Mail Address City State/Zip Phone <br />��v t— <br />Electrical Contractor <br />t�u'�i ��t�'i1 �ILI: <br />State License Number (required) <br />Mail Address <br />S�t,�. ��� (�i 1��i S e �'tTw�J <br />Proposed Use of Building <br />Square Footage (If residential new construction, remodel or addition) <br />�. <br />Number of devices (If low voltage) <br />City <br />State/Zip <br />Phone <br />City of Everett Business License Number (required) <br />� I 'a � C1 �" - C � _ c: [�, <br />Contract Price of Work <br />t�«.v �,'�+.r�i���,�:.�� ��6Lh� Z��-' - /-���' <br />Contact Person/Contact Number/Email <br />Description of Work to Be Done: 1�-� ��.-�`� �.� �- i.�`-�� �%�'`�r=��`1�V�_ �'�Cr✓;aN`-; i�'....ii� 5 <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 granfing 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 consfruction. That I am authorized by the owner of thrs property to perform the <br />work for which application is made and I comply with the State Contracfors Law 18.27 RCW and <br />296.200 WAC. <br />Signature <br />REVISED 08/O6/2014 <br />FEE <br />���� �� <br />PERMIT# <br />E i �o D � � (� �( `I <br />