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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 — vwvw.everettwa.gov <br />,����� ���I� �S �v('�(��' <br />� <br />PROJECT ADDRESS <br />, C.. ,�v, �� <br />Owner <br />� <br />Mail Address <br />City <br />State/Zip <br />Phone <br />� 1J C.,'�� �' � / � �1 1 � �j )� C:/ ��� . <br />Tenant Mail Address City State/Zip Phone <br />�%.�� r L G �; �h <br />Electrical Contractor <br />r� �. <br />t � �:�r���� ;� 6+ G'� .�G��S_ <br />Mail Address City <br />� � L � ,� �=� yr-�, f���.� <br />State License Number (required) <br />i��� �`E' D�'�'T � i C' ��-%�-G � <br />Proposed Use of Building <br />� ,l , :-- .. --_ <br />E .' ) �� � � :'\ �l <br />Square Footage (if residential new donstruction, remodel or addition) <br />P' �� <br />L%J <br />Number of devices (If low voltage) <br />�LC c�,.�1— ��l �Ll l—� v �'S <br />State/Zip Phone <br />v5�� 5�- <br />City of Everett Business License Number (required) <br />c�= <br />� : � �', L�i��'��� "— <br />Contract Price of Work <br />i,v i 4'� ►3� i�}E�C —F'i�� -'�S rLv �',;'i�_ <br />Contact PersonlContact NumberlEmail <br />' �� ,� ��� �,� <br />Description of Work to Be Done: L' I� J� ��� ���`J` /• a-L l f /r S% ,� �� �, % � 'i- ��— <br />�/A �\ � f'Y � i � �� {' �7 i R7 �' C 1 �l/Tt ,T � s ."'f 1�i �J ��r"i /Li � d �.L�' L � /� r'1 � �- �:SS <br />v/ � <br />C <br />; � ti � 0 / �'' �� 6=� -�c� � ' ��-< �� �, � �� � � i,/ %l ! �'`'9 <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerfify that I have read and examined this application and know the same to be true and <br />correct. Atl provisions of /aws and ordinances governing this type of work wil/ be comp/eted <br />whether specified herein or not. The granting of a permit does not presume to give authority to <br />violate or cance/ the provisions of any other state or local !aw regulating construction or the <br />performance of construction. That 1 am authorized by the owner of this property to perform ihe <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 />REVISED 08/06/2014 <br />_�.5 ; <br />Date <br />FEE <br />JS�� <br />PERMIT# <br />El ��� � D�.� <br />