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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 />CQ?�� � <br />., , . � � <br />!, c`%_� _ , i, � ` <br />PROJECT ADDRESS � <br />5�'L(.�fl <br />f�c� r c% i� X 1� e� tr ,�' ��`iCC� ��/>-� <br />Owner Mail Ad ess <br />� J7� LGt hC� i �c � �c1 {� <br />�lx v� Cf �� S f���'�v e <br />Tenant <br />Mail Address <br />`� 1� y I ��� C�`�,Z i�,,;t. c«��c-,,,�7 <br />Electrical Contractor Mail Address <br />� � r'L � L 1 y � -� � -� <br />State License Number (required) <br />�c����-, h,1 �� - �c_� , �� � <br />Proposed Use of Building <br />/�� OC-'C� <br />Square Footage (If residential new construction, remodel or addition) <br />l��i <br />Number of devices (If low voltage) <br />, J _ ' r �, _ . , <br />�. ��;,s�r,- ;4 ��<�-y Sf yo,1�s°� � llE, c� r l � y � <br />City <br />City <br />State/Zip ���G'� 7,�-, �? 5 z 5` <br />State/Zip <br />State/Zip <br />Phone <br />Phone <br />City of Everett Business License Number (required) <br />SC_'�� COC'� <br />Contract Price of Work <br />�z� ��� ���;3 <br />� hri5 /r�>-c l / <br />��.✓,5. "Y'Yci � y �`.�'SiGy�ir��c7��zi'y�cir^i Cc�.. t�e��- <br />Contact Person/Contact Number/Email <br />Description of Work to Be Done: �e1�� ��'+�( C�L��I � y-,_�- �� L v� I�`�J G�l� C! CG /✓ <br />, <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby certify that I have read and examined this application and know fhe 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 sfate or local law regulating construction or the <br />performance of construcfion. That I am authorized by the 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 />. <br />� <br />//, ��� -� � / - --- <br />'Sign�ture Date <br />REVISED 08/O6/2014 <br />FEE <br />,^ O �v <br />J <br />PERMIT# <br />E��07 - C>(��� <br />i.. r't <br />