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� i����� � <br />ELECiRICAL PERNIIT APPLICAiIOfV <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 />��"��� ,�� <br />PROJECT ADDRESS <br />�- � � <br />Owner ' <br />�t � (� �� <br />Tenant <br />,, ,.� � , � � �.: � � <br />���-f� �o � � <br />Mail Address <br />r <br />� <br />Mail Address <br />;� �� ��� � <br />� C� � uc�l,��►t�l `v`� ° �5i�/� <br />s�-� � �.�F�� ��io J <br />City State/Zip <br />City <br />Electri'�al Contractor Mail Address City <br />� �_ �. �� � ���' <br />S ate ic se Number (required) <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 />State/Zip <br />�_ <br />State/Zip <br />Phone <br />Phone <br />�� �1s�= �� 32� <br />Phone <br />City of Everett Business License Number (required) <br />��/ /ll v�-,-�� <br />��� <br />Contract Price of Work <br />Contact Person/Contact Number/Email <br />r�� ��-f� � l�� u ��i � <br />FEE <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 ��� ,,l`;, <br />1 hereby cerfify that 1 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 PERMIT# <br />violate or cancel the provisions of any other state or local law regulating construction or the <br />performance of construction. Thaf I am authorized by the owner of this property to perform the E ��� �.� ��� <br />work for which application is made and 1 comply with the State Contracfors Law 18.27 RCW and <br />296.200 WAC. ,- � ii , <br />nature <br />REVISED 08/06/2014 <br />�-2�- z�i <br />Date <br />