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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.gov <br />� �-�%G MC �-R 1 LL C-r�C�-r� <br />PROJECT ADDRESS <br />E-�C�e1��,w� � `�'�zc�3 <br />l2c � � <br />CR��N(_e_ ��eaS�acE-�,��c�=�N 2�00 ��i�tf S-i_ S�t � ��i: �vC�crr� vvp `�b ���} S��-��''�- <br />Owner Mail Address City State/Zip Phone <br />� i� 'v�,� Fi�' (�u� lol.t r� � 1.�U Q rvt c v<(2 � il., C.+i���' �= i� t� �,, ., ��v � t� t� T, W r=� `� fi��� � ��I�S� `i � S � S L`c� <br />Tenant Mail Address City State/Zip Phone <br />WRS'1-hN�,S�fV �Aw� 2��3� A�2-Pc�2�r WC�u _)� ��cut�r�Q Vv�1 `I�1�1>�1 L2c�b)323-�7SS <br />Electrical Contractor Mail Address ` City State/Zip Phone <br />LU��Sr��� A�� � �? c'3 <br />State License Number (required) <br />��-'1�V1-hYl4 Yf �A �� ' .Jl'. d�'�i V � ����-ti Y <br />Proposed Use of Building <br />C'�s3`�'') <br />City of Everett Business License Number (required) <br />Contract Price of Work <br />� (�� C) C� D <br />Square Footage (If residential new construction, remodel or addition) Contact Person/Contact Number/Email <br />� <br />Number of devices (If low voltage) <br />� lC,..; - v,��i-cx `3�'> <br />Description of Work to Be Done: � l. Y1Y�-�Y�� �`"vz- �� V�-�"-OYI Yik-k-t ���` F�ti �� �r� �. �'1v�h <br />� <br />�P,� �,x �` � � s�� <br />� �� `�- ��C -�' � r e r^t t n r rv� lin v i fi� V, ioCx rt(' i. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />l 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 will be completed <br />whether specified herein or not. The granting of a permit does not presume fo give authority to <br />violate or cance/ the provisions of any other state or /oca/ law regulating construction or the <br />performance of construction. That I am authorized by the owner of this property to perform the <br />work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br />296.200 WAC. <br />nature <br />REVISED 08/06/2014 <br />�'���/��.�r� <br />Date <br />FEE <br />, `1"� _ �� <br />PERMIT# <br />E ����- Y�� <br />