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e. <br /> • _ • —. <br /> 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 '3 <br /> C 13(z--1 <br /> 06 <br /> 3;o Q f)erre.. Eve-v'c}i, t3/11- 982-0 <br /> PROJECT ADDRESS <br /> Owner Ma I Address City State2rp Phone <br /> Tenant tdail Acdress City Stale/Zio Phone <br /> T �leCfr c I/O / i'e stt_8 6;v-ere /,tom- V2Sy 787/o( <br /> Electrical Contractor Mail Address City Slate/Zip Phone <br /> _ 3J.-0U <br /> Stale License Number Contract Price of Work <br /> Proposed Use of Building Contact Person (Plan Re new) <br /> Square Footage(If residential new construction, remodel or addition) <br /> Number of devices(If low voltage) <br /> Description of Work to Be Done. ALA-to/ <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 70 -6-0 <br /> I hereby certify that I have read and examined this application and know the sante to be true and <br /> correct All provisions of laws and ordinances governing this type of work e d!bo 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 pr isrons of any other state or local law regulating construction cr the <br /> performance o.col . n chop. That l am nuthonzed by the owner of this property to perform the E q(0 <br /> work for which a (kation is made and I comply with the State Contractors Law 18 27 RCA'and <br /> 296 200 WAC /' <br /> /. /2-3o -/3 <br /> Si:nature Dale <br /> (43//3 <br /> REVISED170P3 <br />