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ELECTRICAL PERMIT APPLICATION <br /> CITY O� EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857—www.everettwa.gov <br /> 1 � �� �J�. ��'.�� ls��i� ct��) �i�- �s'�-���� <br /> PROJECT ADDRESS �- <br /> o� or�' S �2 � . ��-�l�-o t � . ��.e�.1�- l.t�'�(� ��2.� '..� <br /> Owner Mail Address City State/Zip Phone <br /> c5� <br /> Tenant Mail Address City State/Zip Phone <br /> � � - <br /> Electrical Contractor Mail Address City State/Zip � y � ne <br /> ` ' <br /> �1 LL �v��/�- ��2 � <br /> State License Number(required) City o Everett Busin�ss License Number(required) <br /> . <br /> � � IV\ <br /> Proposed Use of Building Contract Price of Work <br /> �e�� `C2's ` S'Z�1 - �v a� <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: �f" 'j.}�y.}-L(� ��(? �.(�t �/� ��'�yto�,/�,.�- �� ���,� <br /> _ �.�.. �l� � C�w$-I.�- � ��n� <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 � �. �y'� <br /> I hereby certify that I have read and examined this application and know the same to be true and v <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 rovisions of any other state or local law regulating construction or the ^ � �C� + � <br /> performance of c stru tion. That I am authorized by the owner of this property to perform the t <br /> work for which plica on is made d I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WA . <br /> a� �•Z- 1t- 1�7 <br /> Signatur Date <br /> 1/�on M-�.����;,., �.�e,..9.., 7�� <br /> REVISED 08/O6/2014 <br />