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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.gov <br />�✓��i,_�' t` A,��t�� f t:ir'l�"'i iTvi ��t��"1%,�` ��:, !'ly'��- . <br />PROJECT ADDRESS <br />.-� <br />f';/� i d� �1 t' � J'! >� C. � 4` �_� <br />Owner <br />Tenant <br />il Address <br />Mail Address <br />'y'' f, l; <br />City <br />City <br />State/Zip <br />StateJZip <br />�I���;t�r.'� / �/; :� -- <br />Phone <br />..,� ,�' j - 7�;�� � <br />Phone <br />i <br />� `, :�; � t 1=_ ,� � � ,'l l�%�' V't- ( �' 1��.h' f= 7v' � <br />EleCtriC21 Contractor Mail Address City State/Zip Phone <br />State License Number (required) <br />f,, <br />':a <br />TL� f'i ir i� <br />Proposed Use o Building <br />����f' �_S�', � <br />Square Footage (If residential new construction, remodel or addition) <br />.� <br />Number of devices (If low voltage) <br />Description of Work to Be Done: /1 C�CI �i�iG� C�- �G'�� �l� <br />City of Everett Business License Number (required) <br />Contract Price of Work <br />,%�(�1 J�ut�zi�C y�h --���-� 7����� <br />Contact Person/Contact Number/Email <br />� L �;Nc�`) y"Qt�) :�'r��L�4�, � �?12cliL� (' L,2 <br />� <br />i, <br />,-' � C' " G 4 i� l Z ���'' U7 �� .:� L' ��/ t� C� / rC1,l��S ;l� L%L� �7e ��( �cc�( a�' <br />, <br />�� l� i�1�1�� �l YCI,'l� �� fL� r L� L� C� �'► �. <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 not. The granting of a permit does not presume to give authority to <br />violate or cancel the provisions of any ofher state or local law regulating 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 comply wifh the State Contractors Law 18.27 RCW and <br />296.200 WAC. <br />- f�',,-:�i�//�j <br />REVISED 08/O6/2014 <br />FEE <br />��-Od <br />PERMIT# <br />EW�5o8-001 <br />