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1�.I <br />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.org <br />� ( Q`��� <br />'� '� �� � � 3 � =rU��, � i FV � �'� �-fiT �� �,�,� Y� � �r ��.�TT �' �t �1 �j L o ��' <br />PROJECT ADDRESS <br />.r � _ ' ���� <br />fi i�l �'C� (�� � y�� �- i/- �l i� �'� i��ui���e �� kv't �� c� 7� ��w" C vL��'- L T 1 \'�' � 1��'� �� <br />Owner <br />Tenant <br />Mail Address <br />Mail Address <br />City <br />State/Zip Phone <br />State/Zip Phone <br />; 1r1� ��\) i�6i�l� �3 �`"Cr�.7 %7 Cl � � N��4'jT�1;YE/� / �✓K6✓�L�'j W � �� � �G��� G()1..JS_�� f��(c <br />Electrical Contractor Mail Address City State/Zip Phone <br />t�-('P�l 1 ��r' / 6 �D <br />State License Number <br />Proposed Use of Building <br />Square Footage (If residential new construction, remodel or addition) <br />� <br />Number of devices (If low voltage) <br />"T j. (� r`J !'% <br />Contracf Price of Work <br />�r�.�� ��,nrr,.�..�.�. <br />Contact Person (Plan Review) <br />Description of Work to Be Done: Ti`��i�l,l.�".r—L�� � 1� "�i� i�-4 ( 1��/ �� ��^ ���`� � <br />���.��„ cr.��'' ��,� �..r�,t�,�k4 .�' ���✓ `�I� t� `(iti��"-(l-%V��. ��`�.� F'r��-►� <br />1 iJ0 � + � Y/ \ � � �--- <br />/�7� � ry � � r-� \ ��\ � �/ . <br />� {\ Li ' § `�,/�i � L1'`� !�'Y �''..J ��.�� �:`F,/�-�,�J � i� � ��-� �'_: ( _� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby certify fhat 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 to give authority to <br />violate or cancel the provisions of any ofher state or local law regulating construction or the <br />performance of constructron. That 1 am authorized by the owner of this property to perform the <br />work for�t�vl}��ch ap ic�ti de and I comply wifh fhe Stafe Contractors Law 18.27 RCW and <br />296. Zb.b l�/A C. i /� ,�� <br />L�' <br />REVlSED 3/20/13 <br />� <br />FEE <br />� <br />,� 0 � 0 C� <br />PERMIT# <br />E � �D [ � C�O � <br />