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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 />,,..- <. <br />`.z,'� ,'_� <br />PROJECT ADDRESS <br />Owner Mail Address <br />� ._ %} <br />I : � �! i. < � �,� <br />t <br />Tenant Mail Address <br />'� � j 4, i' 4 � (+f . ` � '� ��� �;:� . <br />Electrical Contractor Mail Address <br />'f f `_ ` , f r- <br />State License Number (required) <br />C ity <br />, "P . ` <br />�} ` `5 <br />.` ! <br />City <br />, . . '� j � 4�'-.} ��',w . <br />City <br />Proposed Use of Building <br />�'��, _ <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />��, . <br />Description of Work to Be Done: i� �� �a �--`� ��' �`"�`` "�� <br />State/Zip <br />`f' <br />State/Zip <br />� l,� . i , <br />State/Zip <br />Phone <br />Phone <br />Phone <br />�;� ��= �� � .j <br />�� �,°; <br />City of Everett Business License Number (required) <br />fy� � � � .,_. <br />Contract Price of Work <br />__ -T-- , (s' .. � w� �` <br />t <br />Contact Person/Contact Number/Email <br />_� __ `� } 6 , y .� � � �, �,. <br />.. � /,`� � ; . , ,� (., C� � (� i c <br />FEE <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 �� � <br />I 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 nof. The granting of a permit does not presume to give authority to PERMIT# <br />violate or cancel the provisions of any other state or local law regulating construcfion or the / -� <br />performance of construction. That I am authorized by the owner of this property to perform the E����-' ��� <br />worfc fo which application is made and I comply with the Stafe Contractors Law 18.27 RCW and <br />296.20� WAC. / <br />� . ...+` , .. . . � ^ �"4...... .. ' f + 1. <br />Sianature Date <br />REVISED 08/O6/2014 <br />