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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 — www.everettwa.org <br />llG� �H� ��'rC F� u C. �Z���� 3'=� �ioo�s) <br />PROJECT ADDRESS <br />Owner <br />Tenant <br />Mail Address <br />Mail Address <br />�� <br />City <br />City <br />State/Zip Phone <br />}'l%�' � 7 s ��J � <br />State/Zip Phone <br />�c�c"v-m �b(��'�� �w�_ Iq�Z��vC-u.e.�f !-��.��.#it%� �vF:��"l�A�: �t'�2� � <br />Electrical Contractor Mail Address City State/Zip Phone <br />�� c,i �y �4 po <br />State License Number (required) <br />i�r►E�fC-� <br />Proposed Use of Building <br />�f5� Se� , �'� <br />Square Footage (If residential new construction, remodel or addition) <br />�.O �e � � C� 5 <br />Number of devices (If low voltage) <br />��� <br />City of Everett Business License Number (required) <br />���v_S U .O � <br />Contract Price of Work <br />�l� <br />i3{ZCrSS�.D ��,,�55��2� C'it,ll�.oc c� „�Lry�r� <br />Contact Person/Contact Number/Email <br />Description of Work to Be Done: !f�jl,9-LC���O�' L7� rl�2C- �d-L�/ZYI� ��.� ���.3� ���C.� 2� <br />� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certify that I have read and examined this application and know the same to be frue 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 <br />violate or cancel the provisions of any other state or local law regulating construction or the <br />performance of construction. That 1 am authorized by the owner of this property to perform the <br />work for which application is made and 1 comply with the State Contractors Law 18.27 RCW and <br />296. 200 WA C. <br />.--. <br />t: �__ � %' � - �� - / � <br />REVISED 08/O6/2014 <br />FEE f <br />�����7 <br />PERMIT# <br />E % ��0 l � � �; � <br />�% � �`�`� <br />