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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 r`; � n ��� -S-r-: <br />PROJECT ADDRESS <br />Owner <br />Mail Address <br />City <br />State/Zip <br />Phone <br />�—� ) 4 �- <br />�., / / � ' � %- 7 f.� r '' �' ' .r-rr�- ' P✓ 1 ii�'�� y :.Z.- ? ; <br />c�C'`'1`ZL �l(,r'i jp �i�l ( F'I),�f a>'� G�'�:i'� � / ,k;�-`�� � � _ �� 2' �-, <br />Tenant Mail Address City State/Zip Phone <br />� <br />eJ � C== ��'� ii'z �C �,��- Z -�x�= � �.�-K'�-tt�- 2 }�] i�L�TE���.,�,� i:i;� ���� ��5.. ���- <br />� <br />Electrical Contractof Mail Address City State/Zip Phone <br />.� � l� ��- C�,�, � � �% � i-- D ���� `� <br />State License Number (required) City of Everett Business License Number (required) <br />��7 i�-E� v�'�� IY�. <br />Proposed Use of Building <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (If low voltage) 7 <br />�.�G1"if�"7ii;rLG� <br />� / i� S ���� �- <br />-r-- <br />Contract Price of Work <br />�''_._ ! . � �i 'c_3 _ �!-CY <br />�/�= t�f– Sy/� !C�-'�� S 7��-� -Fu <br />Contact Person/Contact Number/Email <br />,.�J ��='(.,t1C.�.�c � 6�.•�t � �tit'`'`` f <br />�/�i�G=-� %C/TC /t��C:� �r'i��C-�= , <br />Description of Work to Be Done: �/L���-�/��- �'�(�,��CL'CT� ��� ��� �'��'�l�'c% <br />���r�,�-c.��. �iL�; �'T �� �-i�t'-�i� l f��� %�L`l�'��� S�1.2'�� �/�'�v�7�� <br />��li�'�l�'��� � :� � � �f''� � ������%�� ���'���G''��_ �?�; �� ��Z%-/Z�%J <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby certify that l 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 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 1 am authorized by the owner of this property to perform the <br />worfc for which application is made and I comply with the State Contractors Law 18.27 RCW and <br />296.200 WAC. <br />\ ��� C�_..�-;� ,-� -- --7/� V �� c} / � <br />REVISED 08/06/2014 <br />FEE <br />�� �-�� �- <br />PERMIT# <br />E Q�C������ <br />