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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 — vwuw.everettwa,gov <br />���t �1"'�[[ ,�-) / {.L <br />� rv 1' l. �. .,/�/ �/ `��� /� ,�� {v�fl,� I U;V U� 1 f, JL <br />l% 1 �./ �'i/ � 4Y' <br />PROJECT ADDRESS <br />(-I�v � �sti�. l�-1�� l�� <br />Owner Mail Address <br />City <br />�,tIJQ <br />StatelZip Phone <br />����i <br />Tenant Mail Address /�a ��l�/��� �� � State/Zip Phone <br />F� <br />' � ��` fi� � LL� � �rn�,� N c�� �� � `�, I � S � <br />Electrical Contractor Mall Address City StatelZip Phone <br />� t �l 1 i�-�°r C.�.� �,�f � � � ���� �`��� �� � � i �%(1,� " �' � � <br />State License Number (required) City o Everett Business License Number (required) � <br />Cc�✓ C� P�-e�( S �'1. I P <br />Proposed Use of Building <br />�� <br />Square Footage (If residential new construction, remodel or addition) <br />i�o <br />Number of devices (If low voltage) <br />Description of Work to Be Done: i'�--� � <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />v✓ � <br />Contract Price of Work <br />l�� �� �V r�� <br />Contact Person/Contact NumberlEmail <br />°2�� �o�� 810�7 <br />1 hereby certify that I have read and examined this applrcation and know the same to be true and <br />correcf. AI! provisions of laws and ordinances governing this type of work will be complefed <br />whether specified herein or not. The granting of a permit does nof presume to give authoiity to <br />violate or cancel fhe provisions of any other staie or local law regulating construction or the <br />performance of construction. That I am au�honzed by the owner of this property to per(orm 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 />REVISED Ofl/062014 <br />FEE <br />,�j �� (� Ci � <br />�"�� " 1 <br />PERMIT# <br />E �`����' �ZI`� <br />