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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—yy V <br /> �tb'�(,�i �`: .�✓rLF.Q`("`�.��S � �M/fi!`!i[�p' CLC��-��V'. <br /> 065, <br /> PROJECT ADDRESS <br /> -ERA Cl <br /> r <br /> Owner Mail Address City State/Zip Phone <br /> G`�tr1f`�F1�ECv) <br /> Tenant Mail Address City State/Zip Phone <br /> tiv�bIJtU ir5ke- 6 �� �t t�-t�!vi�� � G� 4 � �-� <br /> X `�t L.r�,, i b 5 E`l2 Zca I Z <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> t tI' Cb:"k, T- 30� <br /> State License Number(required) City of Everett Business License Number(required) <br /> nn ] <br /> Proposed Use of Building Contract Price of Work <br /> .T-ICU,"0 T"S e"V o 1),.t U+^.C-- 1v .1 LINk,4;- <br /> Square Footage(If residential new construction, remodel or addition) Contact Person/Contact Number/Email <br /> Number of devices (If low voltage) <br /> Description of Work to Be Done: <br /> �i� r1 (-��/a> 1 (��ti>,�'. 1�t)L�S , .:.:. �f%ir ["-=•r f '' i <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> !hereby certify that l have read and examined this application and know the same to be true and s <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 PERMIT# <br /> violate or cancel the provisions of any other state or local law regulating construction or the <br /> performance of construction. That l am authorized by the owner of this property to perform the E I I ✓ I�� <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> Signature ; Date <br /> i <br /> REVISED 08/06/2014 <br />