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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 />Ll C� ��� ��� �5��. s���;� ���s t- <br />PROJECT ADDRESS <br />Owner <br />Tenant <br />Mail Address <br />Mail Address <br />1���'_3/� -��> <br />���7 �% s f S k 1= r��-e �� w�.� �l� �'� <br />City <br />City <br />State/Zip <br />State/Zip <br />Phone <br />Pho�e <br />i lc�� ,�� ���c�7�'f �"c ��/ Z� ���`� S� .�l��v �f�e��i�%G�i �L/� j�S'Ly2 �/'2S=7E�'-5;. <br />Electrical Contractor Mail Address City State/Zip Phone <br />��c,,r �'�., �3�/��% � �3 ��� <br />State License Number (required) City of Everett Business License Number (required) <br />--�-� <br />��C� �, COC� <br />Proposed Use of Building Contract Price of Work <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />��cv� C��r'� �2� ���� L��6�2 <br />Contact Person/Contact Number/Email <br />Description of Work to Be Done: ��� � CC� � t�/� ��!? S/�2 �� C'ryl�l'� r/ X/�� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ce►tify that l have read and examined this application 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 to <br />violate or cancel the provisions of any other stafe or /ocal 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 Confractors Law 18.27 RCW and <br />296.200 WAC. <br />� — �;�--���/ � � �/ � <br />/ Signature Date <br />REVISED 08/06/2014 <br />FEE <br />���0 <br />PERMIT# <br />E ��b Z. - � �'� <br />