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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 />1 C� I S �� l�, �fir�fi �. ��1, ���,-�r ��, <br />PROJECT ADDRESS � <br />�; �`) f� Y t <br />Owner <br />� �-��c.Girl;c�, <br />Tenant <br />� ' ; —�Ue�� � <br />Electrical Contractor <br />Mail Address <br />�� t, f� l� � � �s�'���- s �;: <br />Mail Address <br />Mail Address <br />�� l��"�I-� i�� �� <br />State License Number <br />�,ip_ ���1 � � <br />; ,:� ��; <br />�� i,L I� ,� �l (i: L-C't �! L'1+� <br />Proposed Use of Building <br />� <br />� _��, ��- ,�� � � �� �`�' -1 <br />Square F otage (If residential ew construction, remodel or addition) <br />�� �( � <br />�� . Jli2���'CC�����C.� Z- C�I.C�{��� <br />Num er of devices (If low vol age) <br />Description of Work to Be Done: <br />�+_1Cc C.�� �'. <br />l�� � � �� J�l �`"C vC c'c` %}� i � -t'-�. S �S <br />:1���� <br />� �� I�� ,s , �-� �. r� lls <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />c�ry <br />State/Zip � <br />�v�'i� `� �z � �. <br />State/Zip <br />iJ��>r� y <br />State/Zip <br />'�, - �� 3 . z �,. <br />,��� <br />Contract Price of Work <br />Phone <br />S� ��;� }-C?G'OC <br />Phone <br />z� ;.`:S�S'� �� �s <br />Phone <br />Contact Person (Plan Review) <br />L%��rl �)�'c���li�� �, Il�'- c�.1�1 <br />/ll ��c��{ C� L�' � �icir.� �/,v i�� � �i�`�� f= <br />1 hereby certify that 1 have read and examined this application and know the same to be true and <br />correct. All provisions of laws and ordinances goveming fhis type of woric 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 loca/ law regulafing 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 I comp/y with the State Contractors Law 18.27 RCW and <br />296.200 WAC. <br />� /� CG / �c7/Y <br />REVISED 320/13 <br />FEE <br />� <br />�� . �� <br />PERMIT# <br />E � �d Z- �S� <br />