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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 /> ��I1�1 lt2^`'� `v� ����-�- ��- °I`�62��' <br /> PROJECT ADDRESS <br /> C�e������ce�,�.�c��" �a�Pl �l`Z�,,a �� ��� ��Z� �'-s�3-tta� <br /> Owner Mail Address City State/Zip Phone <br /> �Nl� �an�s <br /> Tenant Mail Address City State/Zip Phone <br /> ����. �- S' �i <br /> Electrical Contractor Ma' ss City State/Zip Phone <br /> ,�A�-F l�[ ��4- 1�-,-r' �2��a"'� <br /> State License Number(required) City of Everett Business License Number(required) <br /> �, ^� 'r"" <br /> 1�W�-�d��r- �7 F"�Y�A(� "t`�l>U <br /> Proposed Use of Building Contract Price of Work <br /> ��S �P+�' <br /> A�a- G�'� ��-r�t <br /> Square Footage(If residential new construction, remodel or addition) Contact Person/Contact Number/Em il <br /> � z�'�,- 2o2-'�i7�1 <br /> Q+��L. -� 2. ,�r.�t�w.t Clo�-uti--� �i-t+�iS$ � Al���+2�. C�nti <br /> Number of devices(If low voltage) <br /> Description of Work to Be Done: ��� �'XiS^T��lr t'tQ.��T-'S�/C-Vl� '�1� e�NT��'� <br /> ?��, �rn � �s+�w �,� Lr� `'1� vo t_� t�af.�t.. �-L <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 � � � � � <br /> 1 hereby certify that I have read and examined this application and know the same to be true and <br /> correct. Al/provisions of laws and ordinances governing this type of work will be completed <br /> whether speci�ed 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 1 am authorized by the owner of this property to pe►form the E +5 O Cj ...�. �, V <br /> work for whi plication is made an c mply with the State Contractors Law 18.27 RCW and � <br /> 296.2 AC. <br /> �j� � $� 1 S� <br /> gnature Date <br /> REVISED 08/O6/2014 . <br />