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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 />��0 'i�l �r'�� � � ce�,K � <br />PROJECT ADDRESS <br />��� <br />�1.,�.���o <br />Electrical <br />\n� ��rS H:i ,F� i 2 x 2C 3 <br />State License Number (required) <br />Co rvvrv�a�'U c�.� <br />Proposed Use of Building <br />i�.J) V�� <br />7 �.fca �O q �-th <br />Mail Address <br />�� �n �� i <br />Mail Address <br />n. �v�� �03( <br />Mail Address <br />Square Footage (If residential new construction, remodel or addition) <br />� <br />Number of devices (If low voltage) <br />1� # 1� E v'�J� tfi ,1/� A' , Gl,�z�� <br />City State/Zip Phone <br />CZs'a;�� - <br />c��a.� �E'v ��rce �-t ,vJ �1 � q 8'Z � 3 <br />City <br />State/Zip <br />x��, W A <br />State/Zip <br />Phone <br />Zpr�; - <br />3y a��-315� <br />Phone <br />��S 38�� <br />City of Everett Business License Number (required) <br />��, 1aS�. c» <br />Contract Price of Work <br />N�� a�--� 1�;E�-i��n l Z�� `���._��-I� <br />Contact Pe n/Contact Numb r/Email <br />i 1LC( i,t5'�t-�R� �JC1S►'1 � f���v� �c�.c7vt . Cr�d'� <br />Description of Work to Be Done: , ���'-�Q� ►�L� c�`�i ����� 9Y�4 � Q�� �fia fi c��t � <br />(� �c�� c,�d���;r� R � 1�1 c� - �� ��a � c�.� e.x ►� t� �- �f1rc �,� �a�r m <br />:US <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certify that / 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 to give authority to <br />violate or cancel fhe provisions of any other state or Iocal !aw regulating construction or the <br />performance of construction. That / 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 />Signature <br />REV/SED 08/O6/2014 <br />�� <br />�l �/2oi5 <br />FEE <br />���p��5 <br />PERMIT# <br />E � �U �- ���, <br />