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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.or <br /> -� , � <� �r•� �� � < � <br /> a ; .� , <br /> �' Y �'�.. � ) ��� �,� � .,. .' ti_1��(n � �tJ <br /> (, a- U <br /> PROJECT ADDRESS <br /> � pF <br /> � � a� � ti , <br /> -" _ ° ?; ' , � , , - <br /> �� v :� � _ � n ,... � . °�� ��r,r . _ ,�. ��'�-� ;}�"��"�� � ` • � �..�:'�, , ".�� e �n�s.: .._ <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> � ��..:�: �a �' ���'F°i� _ ,. � �:.. �', y�� . �� , .,� <br /> � L� `� i� �a�'e€�a � �, �,a ' �..�. � ���.�.� <br /> Electrical ContraCtor Mail Address C State/Zip Phone <br /> ��°���"" ���'�w � � � �5 I ?�5 <br /> State License Number(required) City of Everett Business License Number(required) <br /> �" � <br /> � � <br /> i, <br /> �,�. �,.�, ,�, " _ � , �-,a� � �� 1�J�) <br /> Proposed Use of Building Contract Price of Work <br /> - :`�__"� <br /> Square Footage(If residential new constructi , remo o di i n) Contact PersonlContact Number/Email <br /> t�;�, <br /> ,= �__._, <br /> Number of devices(If low voltage) <br /> l� <br /> Description of Workto Be Done: �%3� �� �G�.a ��.'3`��a���' �� �+«m, ?�m=-�'r' t =� �`'., m y ��;��`�� .. <br /> � <br /> FE E <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 � f� <br /> _� <br /> I hereby certify that I have read and examined this application and know the same to be true and I � � ' <br /> correct. AIl 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 /> violafe or cancel the provisions of any other state or local law regulating construction or the ,-�,�1 <br /> performance of construction. That I am authorized by the owner of this property to perform the E l 'f M�.- �'��� <br /> work for v✓hich appli �d'n is made and!comply with the State Contractors Law 18.27 RCW and �J � <br /> 296.200 Wi4'C. `� <br /> � i., %` <br /> - � <br /> ��� �� <br /> ,��,s �,� '-'�_- `. � ���� � . <br /> Signature Date <br /> REVISED 08/06/2014 <br />