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ELECTRICAL PERMI� 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 /> �� �� 1 i� � �- ��� �-� <br /> PROJECT ADDRESS � �I 3 J — <br /> .�c n �r S � �� i �� ��� �'�S c���1 S (� �c_(<<�� L= v r7_r�'_ � W��} �� �:� U <br /> Owner Mail Address � �j -7 J City State/Zip Phone <br /> l �� � <br /> S��> ��r �� I� ;�f=� 1����1�rso�s li����<<�r-� L���,��,�� 1� 1�v�- �l �:�a <br /> Tenant Mail Address City State/Zip �6, �one <br /> D r' �'Y' L—[ f'G � e"'lC. � •3 C� ! Sfl I`�c�C ��'TI� �I fJU L� �1//t � �'�� � 7,��._�� � <br /> PG � t <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> �c� iht- � �-- I' `-( � � L � �-I `� � I <br /> State License Number(required) City of Everett Business License Number(required) <br /> �lr_e�� v,� �I'3.� �-_ "� �' �� <br /> Proposed Use of Building Contract Price of Work VJ 9-V � <br /> I �, �� iJle ; <br /> � /� ��/ll d - c� l C �' � -� � C c� iv� <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: /`� � r���C C� �� ~ � y � �'� � � ��1 �l i �( � % 'S � `�� � S � <br /> S-t���� � ���1� �,�,� , y �, �� v��-� � �,-� , �-s <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 ; / ��j ^� <br /> 1 hereby certify that I have read and examined this application and know fhe 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 PERMIT# <br /> violate or cancel the pr � �ons of any other state or local law regulating construction or the <br /> performance of con ructio . authonzed by the owner of this property to perform the E '� �� �` ( � ,3 <br /> work for which ap ication ' made an I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> � � � 7 / — <br /> Signature Date <br /> REVISED 08/O6/2014 <br />