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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 />��L'�' �i�'(;\ ��blL�� �'��'��i <br />PROJECT ADDRESS <br />Owner <br />�,' i,lt �L.l, �� <br />Tenant � <br />> � <br />>�, , �� �.� <br />� <br />Electrical Contractor <br />�� � <br />aii Address <br />Mail Address <br />� <br />ail Address <br />��, � �',..t� �--- � � �'l U l� ���'�� <br />State License Number (required) <br />n `^ l <br />��i� � i G�/��ti� \ �` t <br />Proposed Use of Building <br />t , y ✓v <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />Description of Work to Be Done: <br />(. <br />� ; ., C _l l � ( , '� ;. <br />City <br />C ity <br />;� ���� �tid� <br />�-- <br />C ity <br />State/Zip <br />State/Zip <br />�.,`� ��cGcz <br />State/Zip <br />Phone <br />Phone <br />�s1�v 1G <br />Phone <br />City of Everett Business License Number (required) <br />� ��,� -- <br />Contract Price of Work <br />��y�c,�L�;,L� �?� `�� L l c ��C <br />Contact Person/Contact Number/Email <br />��---� <br />,� �� � � I�� �, <br />� l', ��1;� -�, ����,;��_ � � t��'+� (. l <br />FEE <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 granting of a permit does not presume to give authority to PERMIT# <br />violate or cancel the provisions of any ofher state or local law regulating construction or the 1�• <br />performance of construction. That I am authorized by the owner of this property to perform the E�� l-��;� �`� _�.% -� <br />work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br />296.200 WAC. _ _ I � , <br />Date <br />ftEVISED 08/O6/2014 <br />