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ELECTRIiCAL 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 /> / � 0 <br /> �(%���- � C7 S ^.2 G /�'�d <br /> PROJECT ADDRESS <br /> � � l�� /� `�rU l4w� `�� S. ,�%,1=� G�� S'�<c��� ( �c.��rr�"-�,�/z <br /> Owner Mail Address City State/Zip Phone <br /> ���G L�o 1 :J 'Ltc� Y1 � di�i�.'G� L.✓�� `(� if✓G� � ��/2�/��'`S 7���/� <br /> Tenant Mail Address City State/Zip Phone <br /> � <br /> Electrical Contractor` Mail Address City State/Zip Phone <br /> State License Number(required) City of Everett Business License Number(required) <br /> � �--- <br /> � �`��c�> <br /> ; � S�< «- <br /> Proposed Use of B �Iding Contract Price of Work <br /> ��� r��i <br /> Square Footage (If residential new construction, remodel or addition) Contact Person/Contact Number/Email <br /> � <br /> rU � <br /> Number of devices (If low voltage) ! <br /> I <br /> / �" i �-� � � � � <br /> Description of Work to Be Done: r1 -���-/ � / �-, �l �C-� '� ��%z.�i�,<-_,�� �' <r�/ <br /> � � <br /> l .��Cir�l �`�"_�^ � ti'1"`�``-f� �' � / <br /> � <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 � <br /> I hereby certify that 1 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 pFRM1T�r <br /> violate or cancel the provisions of any other state or local!aw regulating construction or the � <br /> performance of construction. That I am authorized by the owner of this property to pertorm the E `� �'� �' ��� <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 W�.� , <br /> � ° ,�',�%� -- '� - <br /> �' � �% � �7 '��"/_� <br /> Signature Date/� ~` <br /> REVISED 08/O6/2014 <br />