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03/10/2015 TUE 15:56 FAX <br />ELECTRICAL PERMtT 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 />�\ 0�1 �%�� �'% <br />PROJECT ADDRESS ^ <br />lC� u��,� �L c�h <br />Owrler Mail Address <br />Tenant Mail Address <br />Electrica( Contractor Mail Address <br />_state-L7ce�elVumb�r(reqaired)------___.._ _-- <br />Y� � �- <br />Proposed Use of uilding <br />_�` � 1 <br />Square Footage (If residential new construction, remodel or addition) <br />� �� <br />Number of devices (if low voltage) <br />Description of Work to Be Done: <br />�� �Y �S� t � I� �� �i � <br />--� <br />City State/Zip <br />City Slate/Zip <br />x (� ,��>id� I a���J <br />�ooz/ooz <br />__.....__ _ _____.._..... <br />��n"� �= <br />; <br />Phone <br />Phone <br />���il�i � � �� <br />Phone <br />Ctt�E�r� essLicensel�5et(require - <br />Contract Price of Work <br />Q��,�.���. ''�����.DS <br />Contact Person/Contact Nu er/Email � <br />O�l�� ����� �`� � <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cartify fhat l have read and examined this application and know the same to be true and <br />correct. All provisions oflaws and ordinances governing this type of work will be completed <br />whefher specified herein or not. 7he granting of a permit does not presume to give authority to <br />violafe or cancel if�e provisions of any other state or local law regulating construction or the <br />performanc� of construction. That l am authorized by the owner of this property to perform the <br />work for which application is made and l comply wiEh the State Confractors Law 18.27 RCW and <br />296.200 WAC. <br />Signature Date <br />REVlSED 08/06/2014 <br />FEE � <br />� O <br />✓ <br />PERMIT# <br />E ��1�� - ��% <br />