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ELECiRICAL ERMii APPLICAiION <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 />�. � � � � �� �� � L v C" iZ �- T � � �, < <�. <br />PROJECT ADDRESS <br />�/Z� <br />�-� /��`' r� r-� L �. 1 C` 1�' . c�> L� ��7 i� \ � C���� �• C` t� �n°� "� �� C. C; tG; Z y Z.�j L( C�� <br />Owner Mail Address City State/Zip Phone <br />� �' �� e-� fZc- c— i�a ��I;� �c �� Z 1 3"Z �� �Z.:�� � � �+ , �� .� _ <br />Tenant Mail Address City State/Zip Phone <br />''L. � �- <br />C'-rC C"cEcTi�c� .z�.,�. �o�C� i�����iz �L1��t e�yr�►�v���<���� ��� ��$�33� `i�`�-7cj5� <br />ElectriCal ContraCtor Mail Address City State/Zip Phone <br />�,i?la >� c.._ c:: �. � L�`�, 2_� � t��`1 <br />State License Number (required) <br />�jy��=1CC- -5`���Lt C�ZtW�e�E�� <br />Proposed Use of Building <br />�'�(Cv�%��� <br />City of Everett Business License Number (required) <br />�� .� _, <br />� � �k� � � � �ry ( �JT. <br />Contract Price of Worl< <br />�� �` C� �' � i= �=1 c�: �� - o'� iZ�Z r�i C, �- �(:` �� C C 1"� f�r. � t�1 S <br />Square Footage (If residential new construction, remodel or addition) Contact Person/Contact Number/Email <br />� �-��, . `��1� . 1 �"` � � <br />Number of de� es (If low voltage) c: �l, i��'� C__ � 4� � ��'�'`�c `�S �� h-C� <br />Description of Work to Be Done: �c `-L% �- � CY �-� � \ " ` �`"� �'` � c � ` �' �'�`' F� - `"° �� � <br />� l V � s� C- O l.� � �� Zc c r L�'L �: ;= �= � C c-. c� _ �V C- ��- `�' i= �:� c=: t'�-- c�., �� �_L t 1- 5,_ <br />i'1v�p - i2..��CtS �c 1 � Nc,vt ( a'�z;� , <br />FEE <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 I���1 `�)� <br />1 hereby certify that l 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 PERMIT# <br />violate or cancel the rovisions of an other state or loca/ law re ulating construction or the <br />P Y 9 � <br />performance of construction. That 1 am authorized by the owner of this properfy to perform the E��c�� ' I�r�^' <br />work for which application is made and 1 comply with the State Contractors Law 98.27 RCW and ��� <br />296.200 WAC. <br />�' �� , <br />/�� � � � <br />� ��.��-c-�=-,. `�'v�,vc- i �� �Z L l 5 <br />Sianature Date <br />REVISED 08/O6/2014 <br />