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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 />I.� z� i�� �f ti s-�- s; �� S�� ��� L5 <br />PROJECT ADDRESS <br />'�% ��: l�'�L ��r�,:.� <br />% O� ( ,! 1 r %f L`4'�.� �,/ J V/�.( � �,�� 7 � � �l <br />/ ��-'.yi'� /' �_�L�i:;':r.i��> �V J U(,i.� �/�Il'oi��� � /' ✓ / /� c ���" J � <br />Owner Mail Address -� City State/Zip Phone <br />�� � �� <br />.�o�� �,,J� �,,� L� ���` C�� �� f i� �� � N�� �'llr✓.,c� 1,�/� y�'uc;� s < �l _ y r,� - � � <br />Tenant Mail Address City State/Zip Phone <br />/�...fi'iC (i�C� ���C'�J�'�- ! `�� ��X Z�'�/ �!'1�'le"v��l'h � ��'fc'�i 1 �lL� -?f������� `r <br />ElectriCal ContraCtor Mail Address City State/Zip Phone <br />��- /d.SS���c.�:tcse�N� <br />State License Number <br />�..:L :'s � � G c� �� <br />Proposed Use of Building <br />�- <br />��1� C.� <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />� �v � L� � t� l� <br />. _ <br />Contract Price of Work <br />Contact Person (Plan Review) <br />Description of Work to Be Done: __�G /<rt ���,�; , �^,-� � v;,i ��-! ;,�+�J✓. �� � ��'��,,� -�,��� ,L� J r <br />�u� ��c �' �t^._� �� 6�c.1� ��' � 1 i.� i ��c�G.�T ,- �7': rc? �'(c�c K � �� �'�'�� <br />��<-��n.5' •�r �ciw Z�L����'��c" .1 "��✓�r •�O ���r-�5 �„ �'� �•�i ; <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby certify that I 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 wrll 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 state or local law regulating construction or the <br />performance of construction. That 1 am authorized by the owner of fhis property to perform the <br />work for w� appJication is made ar}�l 1 comply with the State Contractors Law 18.27 RCW and <br />i� <br />Signature <br />REVISED 3/20/13 <br />� <br />FEE r � � <br />� �J C� <br />PERMIT# <br />E�uay_�7�� <br />