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03/23/2015 MON 17:58 FAx <br />�003/003 <br />_ _ . ___ _ <br />ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREEi, 'EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />'.�,1�'� S�t��l'P�� <br />PROJECT ADDI2ESS �� <br />������ ���5 <br />owr,er <br />N�� <br />Tenant <br />��Y���anc�r�.� , p�ri <br />Electrical Contractor <br />Mail Address <br />Mail Address <br />Mail Address <br />N���I�� � Y�S��II� `w� �2 <br />Cfty State/Zip <br />City State/Zip <br />� I�t�r�.rno�,W�R �t`bZ� ; <br />Cify <br />State/Zip <br />Phone <br />Phone <br />>�� <br />Phone <br />M� �,�� CC ��� `'�i b���zz <br />._. <br />Sfate-L-icer�se�Vumber(req�ired}------ --------------------City-ofEveret�Busiaess-L€cens�Number(r�quired)� <br />r�.Q.�� c�� � � �1,D� <br />Proposed Use of Suilding Contract Price of Work <br />� �� � �� �;�. ���u.�� �o <br />Square Footage (If residential w construction, remodel or addition) Contact Person/Co�ta Numbe /Em i �� y <br />d��,���m������ � � <br />Number of devices (If low voltage) <br />Description of Work to Be Done: <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I� <br />l hereby certify that l have read and examined this application and know the same to 6e true and <br />correct. Al/ provisions of /aws and ordinances governing this type of work wi!l be completed <br />whether specified herein or not. The granting of a permif does not presume to give authority fo <br />violate or cancel the provisions of any other state or local law regulating consiruction or the <br />performance of construction. That I am authorized by the owner of this property to perform fhe <br />o for which a plication is made and ! comply with the Sfate Contractors Law 18.27 RCW and <br />s . oo wAc. � n „ <br />R�VlSED 08/O6/2014 <br />l � <br />F�EE <br />� �2.0.� <br />PERMiT# <br />E���-n� <br />