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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 />I�ICi�! Z io� �r `7 r. <br />PROJECT ADDRESS <br />� <br />�t � r� I � (� �Z 7 � � � ,,� Q :- 5 �, FU � � �� � �t,�!� �`;� �' �Ut? � � `�(,�:� ; `� `� 7 <br />Owner <br />S�ML <br />Tenant <br />Mail Address <br />Mail Address <br />City <br />City <br />State/Zip <br />State/Zip <br />Phone <br />�k�t� L E.LEC T�l.�. �kCsi �� v�:,�.�tk�L /'!I/$ F v::,Qk' tQ- ia/1� �1 `� � i `>..7 S`1 S`� - I?�i <br />EleCtriCal ContraCtor Mail Address City State/Zip Phone <br />i��1b�L�Ei �1�Gl�L� <br />State License Number (required) <br />Proposed Use of Building <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />Description of Work to Be Done: `�-4,� ic ;, ^ IV e w Jc�c cc <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />VJ L1J�� <br />City of Everett Business License Number (required) <br />� C.7C� , C!�= <br />Contract Price of Work <br />�►o�u ST�U�tilS 3l�U 'LL� l -�5�11 <br />ais�zvcv►�@dr._l.,I zl�e$v�i�.t�w� <br />Contact Person/Contact Number/Email <br />�pC�IY <br />1 hereby cerfify thaf I have read and examined fhis application and know the same to be true and <br />correct. All provisions of (aws and ordinances governing this type of work will be completed <br />whether specified herein or not. The grantrng of a permit does not presume to grve authority to <br />violafe or cance! the provrsions 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 / comply with the State Contractors Law 18.27 RCW and <br />296.200 WAC. . <br />�3( 2��5 <br />REVISED OB/06/2014 <br />FEE <br />� /�� ` �l � <br />Lu <br />PERMIT# <br />E ) ���K- '�1 <br />