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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.org <br />� �� 4� I-��' UJ ��-1� E�`� � � �� <br />PROJECT ADDRESS <br />Owner <br />Tenant <br />Mail Address <br />Mail Address <br />City <br />City <br />State/Zip <br />State/Zip <br />Phone <br />Phone <br />`jJ 1`�'\� ('1�� ��1.� �1�- 1 ;ti �- 5�1� ivJCJ�ri �1� �t`'6 �--`� �. �nL� ���7 j� J� <br />Electrical Contractor Mail Address City State/Zip Phone <br />���'��` l�. l OUC� K"Lr <br />State License Number (required) <br />I�.>pl.C�r <br />Proposed Use of Building <br />`� �' ���� <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />Description of Work to Be Done: <br />N��� ���1_.� x <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />Q�Jr� ��.3 � <br />City of Everett Business License Number (required) <br />IW,. b .cx� <br />Contract Price of Work <br />Contact Person/Contact Number/Email <br />Z�� �t� �C��'��; <br />I 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 goveming 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 other sfate or local law regulating construction or the <br />performance of construction. That 1 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 />� �-�>-----_� � ��- � J• <br />Signature Date <br />REVI SED 08/O6/2014 <br />FEE <br />� l`�-�,�� <br />PERMIT# <br />E t � 05-�5 <br />