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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 />C� �� � � �% � � /�v�e, W 1= U� �� � --�- Sv � � �.`�a. <br />PROJECT ADDRESS <br />1 C'I i )v �^ � i� �� � � ��v `� � �� �"l S \ � �� �� l��l`E' f'� �F- \ r V1/�rl <br />Owner Mail Address City State/Zip Phone <br />5 v i k�e. l�} O <br />i��st r �� sr �. �� � L? � ��% �- �. /�- � l�1 L v� � e-E�� <br />Tenant Mail Address City State/Zip Phone <br />( / � �Z�i � �� � C� � L . �� � � `� �%l ��1�� �-�-f1 � V , � $� ��� � �--�� � �-- ��l/� � � U � � <br />Electricat Contractor Mail Address City State/Zip Phone <br />I� C U l_s � N���'l �� l= <br />State License Number (required) <br />Cv m �� � � ��. �, �-�- � <br />Proposed Use of Building <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />� L�-�� l �� .� <br />City of Everett Business License Number (required) <br />�a 5 U� � <br />Contract Price of Work <br />< �1—l`'v <br />J .� 1 � , �� c` ,^� � .� `i�. t : � - � J_> - L'� �7 � <br />J JS �-�Yl c;' J(��.� f.'� E( C' ��S �tC. . i1�E':-4- <br />Contact rson/Contact Number/Email <br />Description of Work to Be Done: � `�� �� �- � � - �� �� � �-f'.�'��,r �� � . � (i �� � �, 1 � �. ��� VI ����r ��� <br />l. �t Y� � �� Qi ; n L� i. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I 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 the owner of this property fo perform the <br />work for which application is made and I comply with fhe State Contractors Law 18.27 RCW and <br />296.200 WA,C. <br />REVISED 08/062014 <br />FEE <br />�l� <br />� ��-� �, � <br />PERMIT# <br />E 1�0�- �?�� <br />