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�L�CTRICAL PERMIT APPLIC�iTION <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� �� �\�L L- vc= r�,L � 1 �lyy.} <br />PROJECT ADDRESS <br />; # 223 <br /><<,:�,�� ��c;;N� �� i� �: � �►5 � �� S��r�.c w,� �N�oz ._- <br />Owner Mail Address City State/Zip Phone <br />Tenant <br />Mail Address <br />� <br />City <br />State/Zip <br />�� <br />Phone <br />/"lt�'S L�� c:..T��L ��i�� �ox �U1 ! tzt=� I �� �( b� VV,� ���Zy� -����' <br />3c:0 3� ( <br />Electrical Contractor Mail Address City State/zip Phone <br />�� �= i� r� Z�� � <br />State License Number (required) <br />I��t�i r��-- <br />Proposed Use of Building <br />7 ��r �' ` I,�1 <br />Square Footage (If residential new construction, remodel or addition) <br />/1l '/? <br />Number of devices (If low voltage) <br />Ci " �1L'(� <br />� � 1 �� I`� <br />City of Everett Business Lic nse Number (required) <br />�Ci''�%�i ' DU <br />Contract Price of Work <br />i'�1 r��� 3:,O - jL �_.. �� �i � <br />Contact Person/Contact Number�ail <br />Description of Work to Be Done: i� �-- (� lk� `"� i L �ti -� S i Y� I S" 7.7i� i�.c �� 1 j <br />k�.�r ��� c K �,- -�- �-� i i-� � � � i �* 1 __ � i�� c�-+ �. ` K n;� ia ( I ;; ni � i S <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 /aws and ordinances goveming fhis type of work will be complefed <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 fhe <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 corriply with the State Contractors Law 18.27 RCW and <br />296.200 WAC. <br />:— ' ! — <br />� � `C , ✓ l _�.,: � ! "� ^ ! J^ <br />� Sianature Date <br />REVISED 08/O6/2014 <br />FEE <br />,-,-�� n � <br />�� <br />PERMIT# <br />E���G(-��+� <br />