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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 />� <br />� � l L�-�� Wnlul <br />PROJECT ADDRESS <br />Owner <br />�� U� <br />Mail Address <br />City <br />State/Zip Phone <br />_.��41i,� � l.il.�- I�l�'��I�N`�%iL f�L'8 .a G.�+-��r=' � ���� �-�+2�N4a�J f`��.�a�. � 4'rr(�rT �-w'�f �!�S-�.�"�-i7�i <br />Y <br />Tenant Mail Address City State/Zip Phone <br />��� `L �.LE.t. Tr�l.� _3k�2�t P�i� a�,t���L Avt F ��,.¢�: tr ivl� �1 � 1� � `�.7 f � 1 �� -17�� <br />Electrical Contractor Mail Address City State/Zip Phone <br />�O�t��i�Et �1�La1� <br />State License Number (required) <br />Proposed Use of Building <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />� � � � �� <br />City of Everett Business License Number (required) <br />� �i 5-:� . L°�' <br />Contract Price of Work <br />i�1o�u .�i�U�hlS 3LU'�sfo�-OS[t <br />�S�GVGv�S�(�:.�) tICL�N1�.fGi'V� <br />Contact Person/Contact Number/Email <br />Description of Work to Be Done: �:' !I't',f.G( tT TD �: l�,"� (v �� d�{ T'��/� �D✓+��i' I•wr3 ;pr' <br />_ ! nt �''� ��Lo✓►� �.('�l�yv�'; � �T �'�,: �1, <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby cerfify that I have �ead and examined this application and know the same to be true and <br />correct. All provisions of laws and ordinances governrng this type of work will be completed <br />whether specified herein or not. The grantrng 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 construcfion. That I am autho�ized by the owner of this property to perform the <br />work for which application is made and 1 comply with the State Contracfors Law 18.27 RCW and <br />296. 20�k4�.,�C. <br />/ 1 � `' <br />.� ' �"��+,15 <br />1 j y. <br />nature <br />REVISED 08/O6/2014 <br />Date <br />FEE <br />PERMIT# <br />E ���� 1�2 <br />