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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 />���� � t/`� i.'�l�,l l_ e 1ti�� u i-� �� - <br />PROJECT ADDRESS <br />�� i�i., i�y � AC �`��'1i�'�. ��.�� �.:� �`'�ui9:�i-� ' ' '� ' <br />LCi � ��:J Jl . i z.�i.C-t�w 1 W,/� � � :r� � � <br />Owner Mail Address City State/Zip Phone <br />Tenant <br />Mail Address <br />City <br />State/Zip <br />Phone <br />�\•�- 1^�-l�C;i��v �i��� ;'�i'ki 1�11�i1•r �Ji, SI-�S►=l.l�+�� �R ��1�7 �Ub� ��.�'�,J7� <br />EleCt�lCal Contractor Mail Address City State/Zip Phone <br />P. � � ���'�; '� �i�'� 1 <br />State License Number (required) <br />_ <br />�I � ��..5. <br />Propose Use of Building <br />�� Ci� � (�, ��, <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />�•��� e� �. (c�27�1�f <br />City of Everett Business License Number (required) <br />� 7.��'�.� <br />Contract Price of Work <br />� � c:.� � �I` :.�, q �, it� ZJE; - � �ri ' .� �'j � <br />Contact Person/Conta Number/Email <br />Description of Work to Be Done: � l� �i1 L l�"S �" �L,1��—��� i�G.-�%.> l;ai i�Jli C-- �:��:�� <br />1� �^.�� �� �� t A �, t-t' _ Yu�. �2.Z..z% �✓�� _ i/� �3�.iJ'� ��'�':�l \'cll'_ �� 1i� . � 'u �b�'1 5 <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />! hereby certrfy that ! have read and examined this application and know the same to be true and <br />correct. All provisions of /aws and ordinances governing this type of work will be completed <br />whether specifred 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 consfruction. Thaf 1 am authorized by the owner of fhis 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 />u - ',�'"1— <br />REV/SED 08/06/2014 <br />FEE <br />�� � <br />PERMIT# <br />E�������� <br />