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ELECT�ICAL 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 />��� ' i� � � � � � � ��--� � �� <br />PROJECT ADDRESS <br />� � <br />��J ��, � � �v � �' Z � (� , <br />Owner ail Address <br />Tenant <br />� �;. <br />Electrical Contractor <br />� , <br />Mail Address <br />�� � <br />�� l i <br />� Mail Address <br />C ity <br />City <br />1�21 � i ��.��a�l� <br />� ;=(�) �(---c, -� � �,'�� j� � <br />- State License mber (required) <br />� .�� � <br />___ __�_.__.____------._____ ___.._ __ . <br />Proposed Use o uilding <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 />State/Zip <br />State/Zip Phone <br />�'-� i 1�����'� L� :�-�-- <br />, <br />City (- IState/Zip ��,G.- L�3� _ Phone <br />�.� z��i � <br />� �� c��� <br />i y of Everett Business License Number (required) <br />�7� c� <br />_� �>( � <br />�ontract Pr.ice of VVork <br />�:�-�- �:���.L�:� `�L� �� z� <br />� � � G �,'l`�1 <br />C tact Person/C�o tact Number mail <br />�t �� <br />�1 L�� � <br />�v <br />1 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 complefed <br />whether specified herein or not. The granting of a permit does not presume fo give authority to <br />violate or cancel the provisions of any other state or local law regulating construction or the <br />performance of consfruction. That 1 am aufhorized by the owner of this property to perform the <br />work for wl�ich application rs made and 1 comply with fhe Sfate Contracfors Law 18.27 RCW and <br />296.200 WA,C. r , , <br />re <br />REVISED 08/06/2014 <br />�\. <br />FEE <br />;� �c� <br />PERMIT# <br />E� j�� � j �� <br />