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� <br />ELECTRICAL <br />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 />- � � � ---1 �� �-�. � I � <br />.�, <br />PROJECT ADDRESS <br />Tenant <br />5I1 '���i��� ('1 �� � �� �.�z �- <br />Mail Address <br />Maii Address <br />�'���� ,�� � ���c ��; � � C � � <br />Electrical Contractor Mail Address <br />� f�`� �� �- :S �- � ���� }� � <br />State License Number (required) <br />,�E 5< <i't;'�'7'T� �'1 / <br />Proposed Use of Building <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 />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />c��y <br />City <br />V,; A- � � ��- ��`3 <br />State/Zip Phone <br />State/Zip Phone <br />� ���' �� �� =� � � �' �s 7�� <br />State2ip Phone <br />�� �� �� <br />City of Everett Business License Number (required) <br />��� � � <br />Contract Price of Work <br />Contact PersonlContact Number/Email <br />l hereby certify that I have read and examined this application and know the same to be true and <br />correct. All provisions of /aws and ordinances governing this type of work will be completed <br />whether specifred 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 ! 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 />�Z � 't� ti <br />REVISED 08/O6/2014 <br />FEE <br />�� oa <br />PERMIT# <br />E � ���-��� <br />