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. ;.: <br /> ; : ELECTI�ICAL PERMtT APPLICATION <br /> CITY OF EVERETT PEi�MIT�SERVICES <br /> : 3200 CEDAR STREET, EVERETT, V1/A 98201 ' : . <br /> 425-257-8'810 - FAX 425-257-8857=www.eVerettwa,org ' - <br /> I d �2: � t�o�G� S�- ��r�r� <br /> PROJECT ADDRESS <br /> c.�.�iVC�. \,.�1�� . <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Addcess ' City StatelZip Phone <br /> f�V)��A .rr� Ete�h2��n� I°v�o,�2!a�� 5h��n�t�L►: t.�c�.._ �£2si c zS'3 7��'1�� <br /> " Electrical Contractor Mail Address City. State/Zip Phone <br /> �1, (,c,; L��c� � : � �d -' <br /> State License Number(require ) City of E e ` Business Licens Number(required) <br /> �✓ . � C�'C... <br /> Prop, ed Use of Building ' Contra Price of Work � <br /> , C <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: 1 ' � � Z UL7 (�'c S �7� <br /> D�n s �i �� � <br /> FEE <br /> CITI(.OF EVERETT LOCAL SALES TAX CODE IS 3105 � ;�O <br /> 1 hereby certify that I have read and examined:this application and knowthe same to be true and <br /> � <br /> correct. AIP proVisions of laws and ordinances goveming fhis type of work.will be completed . <br /> whether specified herein or not: The granCing of a permit does not presume to give a,uthority to PERMIT# <br /> violate or cancel the'prowsions of any other state or/ocal law regulating construction or the � � � ���r ( <br /> pertormance of construct�on. That l am authorized by the owner of this property to perform the � `-'t <br /> work for which applicat�on is:made and!corr►ply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. ` , <br /> / � � <br /> Signature Date <br /> REVISED 08/06/2014 <br />