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ELECTRICAL PERIVIIT �1PPLICATION <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 />� � � �� cj-� .J �J <br />�- � <br />PROJECT ADDRESS <br />� �, <br />� -, �. <br />,� <br />O ner <br />Tenant <br />�% �J Y� �,,� <br />Electrical Contractor <br />�ii�.�l� � <br />State License Number (required) <br />�� �7\��'����1�.� <br />Proposed Use of Building <br />Mail Address <br />Mail Address <br />Mail Address <br />Square Footage (If residential new construction, remodel or addition) <br />_ __--, <br />Number of devices (If low voltage) <br />Description of Work to Be Done: <br />� �� <br />C� � <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />=: ��� : <br />City <br />C ity <br />C ity <br />State/Zip <br />State(Zip <br />State/Zip <br />�(��z� <br />Phone <br />Phone <br />Phone <br />City of Everett Business License Number (required) <br />Contract Price of Work <br />Contact Person/Contact Number/Email <br />�� � �� �, <br />����-� ���- <br />A v ,� <br />✓ r�, i�.� ��;,-'� .f� h P� �. � /�' I,�'s.�lli�;U t <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 fhis 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 ofher state or local law regulating construction or the <br />performance of construction. That I am authorized by the owner of this property to perform the <br />work for which application is made and 1 comply with the State Contractors Law 18.27 RCW and <br />296.200 WAC. <br />nature <br />REVISED 08/06/2014 <br />FEE <br />r_��. ��� <br />1 <br />PERMIT# <br />E � � ��� -� � ._ <br />