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ELECTF ICAL 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 />, �'%-' �'Y.� �-��'� �' �,i'' ' � ; %; .r,� � l <br />PROJECT ADDRESS <br />%�/ /T� � <br />(��/ , j / �-- , 9 < �.� ,� , <br />i�! `% �// , /=� ' G' �.� �� � i" r� -ii� �/tf���"�� ��'� �f/�l.._✓ �? J �/ l ��� ! ,, (. , ti / / <br />Owner% Mail Address City Stat %Zip Phone <br />� _�r'���'f 7L�i'-" /'��,_� 'Y j� �: �> <br />Tenant Mail Address City State/Zip Phone <br />���G� ��=1 � i �L� �i�' – fif�1� l%�"�� ����'l <br />Electri�al Contractor Mail Address City State/Zip Phone <br />State License Number (required) <br />�-��l2�%�`l�-� C�:?7�'� <br />Proposed Use of Building <br />% ".%�2: .-�= <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />City of Everett Business License Number (required) <br />�' .�; ���- <br />Contract Price of Work <br />' t�/� i� � �f )�� � ('� ��._ � J'� �� - �`� �; �, <br />Contact Person/Contact Number/Email <br />i_��G�',•;�'G!_ � � � ( �I �`4? �,/�"�. '_��S��C t.. , ��� ��;� <br />/ V <br />Description of Work to Be Done: -�-'��/,�i�G�L ``�j G���� ! Jy'- >'(/��/� �{%�%i� � <br />(i:i'Ll f �� X�'l � /,/'�? � �����✓?�� �' �ht,�lc �."; �>�� ,�ZiV'; <br />; ` <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <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 /aws and ordinances governing this type of work wrll be completed <br />whether specified herein or not. The granting of a permit does not presume fo give authority to <br />vrolate or cancel the provisions of any other state or local law regulating construction or the <br />performance of construction. That 1 am authorized by the owner of this property to perform the <br />work for which application is made and 1 comply wifh the State Contractors Law 18.27 RCW and <br />296.200 VJIA£. , � /; <br />i� <br />✓ , �1 , ,� <br />i <br />/ � ;, �/, ,, <br />L, ` � C ' � _ — - � 7'� ��.���- l��'. <br />Siqnature D te <br />REVISED 08/06/2014 <br />FEE <br />��Z�;a <br />PERMIT# <br />E15�C�-C'�/� <br />