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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 />� Z�� � 1'Z `—`� S � S� <br />PROJECT ADDRESS <br />Owner <br />Tenant <br />Mail Address <br />Mail Address <br />City <br />City <br />State/Zip <br />State/Zip <br />�--'� �=-C�i= C,- i�z l�� N� 12`t_ ��3 `= S� 5�..� L�i� �U �.� �x� �1 l� � <br />Electrical Contractor Mail Address City State/Zip <br />:3 � L L., t=�..l �(`�l Z �S �S <br />State License Number (required) <br />� i �'� � �2Ca^-%' I <br />Proposed Use of Building <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 />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />Phone <br />Phone <br />r, � <br />C �J <br />Phone <br />v`� � �� � <br />City of Everett Business License Number (required) <br />l (; � � � 3� <br />Contract Price of Work <br />l� �> >-xo,� Lz�� j 3� <br />Contact Person/Contact Number/Email <br />3 �N_le_ �%`(� L���,',,��ti.� � <br />k:1..� 5�'�� \�Yo/L� c't,�` ,�� �� r� /y�-C <br />1 hereby certify that I have read and examined this application and know the same to be true and <br />correct. AN provisions of /aws and ordinances governing this fype 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 cance! 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 this property fo perform the <br />work for which application is made and 1 comply with the State Contractors Law 18.27 RCW and <br />296.200 WAC. <br />REVI SED 08/06/2014 <br />�� zz <br />Cv�v�. <br />FEE <br />� j52 �� <br />PERMIT# <br />E 1�-�- I l- I ��. <br />