Laserfiche WebLink
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 />� ��� r � ����� �� �S ��: � <br />PROJECT ADDRESS <br />Owner J <br />1 <br />._-- <br />Tenant <br />i �a . � <br />� <br />Mail Address <br />Mail Address <br />Electrical Contractor Mail Address <br />—� a 5 ��' �I ���,L7 <br />State License Number (required) <br />�� <br />, �- �� i �I`� �- <br />Proposed Use of Building <br />City <br />City <br />�L 1�Z- l,U t � �`�' <br />C ity <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 />`� /./ I� l:� <br />� <br />G <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />State/Zip <br />State/Zip <br />Phone <br />Phone <br />,�� y ��tl+L.,i�a ��� _ Z� . <br />Stete/Zip Phone <br />�� P✓ 1�W J� <br />City of Ever�tt Business License Number (required) <br />� lE���: <br />Contract Price of Work <br />Contact Person/Contact Number/Email <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 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 staie 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 I comply with the State Contractors Law 18.27 RCW and <br />296.200 WAC. i <br />� U �27 ��" <br />REVISED 08/06/2014 <br />�— <br />FEE <br />_..�G--, � � <br />� � <br />PERMIT# <br />E f���-l�o <br />