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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 />� � �� � � ��� �' ,��'-� � S� ..� �- � �-4- C'� <br />, <br />PROJECT ADDRESS <br />PU��. ��-r��n�� �-e�'���Q�r�n���- ������C� �v�� �n�W./J ��kf-(� �T�- �'I Ql `�� ��1s�-��%7- <br />O nw er Mail Address City State/Zip Phone S��U <br />T <br />C���C� \ �����" <br />Mail Address <br />C.,�� -���-� v�� �i �aa�3 <br />City State/Zip Phone <br />C�l �� � � �.� �, �s�� � `� � �, �� � 1�v � s h ��� t-�,� ,� 5 �- �'� � i�:� � �r� Gt� � <br />Electrical Contractor Mail Address City State/Zip �_ one _� _ <br />�'> -" 7� <br />������ ��)� v�1�� �� <br />State License Number (required) <br />�'.�� �rn�rn����,.,.� � ��T � <br />Proposed Use of Building <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />i������,�_ <br />City of Everett Business License Number (required) <br />�-j l <br />� � �� l� <br />� <br />Contract Price of Work <br />, � � 1- �'�r� (� rc"n h�" � <br />�,5� � �i �-(`�C75 ���'Nc�v���(')�Se�l��C4!_ <br />Contact Person/Contact Numbe�r/Er`r ail <br />� , i i i . �' �/� i , /r� - � ��', <br />Description of Work to Be Done: ��� I{J�/ �� ��-[Jl,� � -'� V��� r l-'1 /�U�'t f�; ,'�,' �.� <br />ilCti(L��� i �l �� �i ��" ���v�i� �'��C,v"J1'l.e � c� ���� �,� � L'L'�v C CCA� �6 ��� i S C \�C��.•..) � ' � <br />� �<��'1,-���t�-�I �C, ('�lC.�'�' G���. �-� C C `� � l��G:s �I'LU-�'� �- `'V �% ��C <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. AII 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 1 am authorized by the owner of this property to perform the <br />work for which a. ication is made and I comply with the State Contractors Law 18.27 RCW and <br />296.200 WAC' � <br />._ /� ,� / � <br />„ � <br />, <br />L <br />REVISED 0 8/0 62 0 1 4 <br />FEE <br />1 l �l 3(/ r L 3 <br />PERMIT# <br />E ��o�—�?�� <br />- ( �c'U� <br />