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� � <br />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 />� <br />� `') �� s f-�� �� ��-� � � <br />PROJECTADDRESS ��,:��}F��+.�.�- ��� (����� �e�ti�''���1 ��'�- <br />�'���z, ����� <br />� "fe�•�+�,��cc <br />��� ���� u�� <br />�C�L� <br />��'� �� (. 1`Y� �>'j��:r—� � 1 v I CJ�1 f� S j S�'� L-'l'1 SJ;'�i.ua.:�rf� ��^ �� lTi�� ���iS Z <br />I <br />�6wrT2r- Mail Address City State/Zip Phone <br />Tenant <br />Mail Address <br />C ity <br />State/Zip <br />Phone <br />� � � � ��\� 2� �zS � � �8 `�" � � � �� � ����� �- t,v � �i� 2��� � i zS � � �� � c�'�`-� <br />Electrical ContraCtor Mail Address City State/Zip Phone <br />�� � � �� `3 �� Sb�L1 <br />State License Number (required) <br />Proposed Use of Building <br />� <br />Square Footage (If residential new construction, remodel or addition) <br />c� �i � �g -� <br />City of Everett Business License Number (required) <br />� �-��d� <br />Contract Price of Work <br />��;� C, � � �U�:�i�,'� ���� <br />Contact Person/Contact Number/Email <br />/ � <br />Number of devices (If low voltage) <br />�� � 1�� <br />Description of Work to Be Done: � �i n �� 1 �rt"il�' � � � �J �' � '" �- �,�v �`� , � � <br />� � r; :�. � �� x , J � � � . � , �� � � � \c��r�: �'j -- � � �� <br />�� �; �r��c� �; <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certify 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 <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 this property to 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 />/"'_ ! <br />�.:--' S' nature <br />08/O6/2014 <br />�1 /� �1 �-% I 5 <br />FEE <br />PERMIT# <br />E � S�Q �� <br />