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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 />� � C � �e �► � � �► �� <br />PROJECT ADDRESS <br />Owner <br />Tenant <br />Mail Address <br />Mail Address <br />City <br />City <br />State/Zip <br />State/Zip <br />Phone <br />Phone <br />s �1 o�J ;��� L� %� ��.�5 �l� c_ �D��� v2� � �%�f � p �� l `��.5 - �.5`c�5���:�.s <br />Electrical Contractor Mail Address City State/Zip Phone <br />�5��vw �� L; 9�� �Y.� <br />State License Number (required) <br />— �'S� \ �' 1�1 � r �__--- <br />_....._ _ . ---__. _. __.. _ __ _ <br />Propos2d Use of BuiiGing <br />� � C. U <br />�� U <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 />(� � %' � � � C�% <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />aS�� c�F� C� <br />City of Everett Business License Number (required) <br />Contract Price of VVork � �/ i_/ <br />r_�/ C Z `"� � T,{� <br />�/�Z5 7.5� �� -�S� � 7 S <br />Contact Person/Contact Number/Email <br />I hereby certify that I have read and examined this applicaiion and know the same to be true and <br />correct. All provisions of laws and ordinances goveming this type of work will be completed <br />whether specified herein or not. The granting of a permit does not presume to give authority fo <br />vrolate or cancel the provisions of any other 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 1 comply with the State Confractors Law 18.27 RCW and <br />296.200 WAC. _- <br />� <br />5iqnature <br />REVI SED 08/06/2014 <br />� � <br />����-��'�l5 <br />FEE <br />� � �� <br />PERMIT# <br />E �U ��� c � �� �.� <br />