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ELECTRICAL PERMIT APPLICATIONE(Q�[thV <br />CITY OF EVERETT PERMIT SERVICES El <br />3200 CEDAR STREET, EVERETT, WA 98201 APR 0 4 13 <br />425-257-8810 - FAX 425.257-8857 — www everettwa org <br />-3 PUBLIC Vd ARKS <br />PROJECT ADDRESS <br />Owner Mail Address City Slate2lp Phone <br />Tenant Mail Address City SlalerZiP Phone <br />W6n9 <br />FAG 3iy�( C� A.'F Sw.�t2 t �kbwr�► w� q9 oo z <br />Electrical Contr for Mall Address City Slals0l) Phone <br />F, Cc- oyi" sf 3 el- 'Y <br />State License Number Contract Price of Work <br />n ( Z9 I�Ek.r[= [(A-1,5 'ta-- <br />Proposed Use of Builffing Contact Person (Plan Review) <br />h, <br />Square Footage (If rere.tidential ne construction, remodel or addition) <br />-�V <br />Number of devices (If low voltage) <br />Description of Work t/yta o Be Done 2�JP. t;y r i (7 e--z QlL-zL�- it <br />to <br />v <br />FEE <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 I (g 3 F <br />I hereby certify that 1 have road and examined this application and know the same to be true 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 PERMIT# <br />violate or cancer the provisions of any other state or local law regulating construction or the E (� <br />performance otconstmam authorized That I aauthorized by the owner or this property to perform the L <br />work for which application is made and I comply with the Stale Contractors Law 18 77 RCW and <br />296.200 WAC. <br />` Signature -� Date <br />ncvisco r�ai� <br />