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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 /> PROJECT ADDRESS <br /> S Abi-T14 K r /1-a t, t S <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> �- C_ pK.SEGeej'rZIG 1Arc 332_2 (3z Pc $ J L.)(4v4eao <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> C P C �� loco $ C <br /> State License Number Contract Price of Work <br /> Proposed Use of Building Contact Person (Plan Review) <br /> 3C)d <br /> Square Footage(If residential new construction, remodel or addition) <br /> Number of devices(If low voltage) <br /> Description of Work to Be Done: ( `� l �d`�S� <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 [ L0CA) <br /> I hereby certifythat I have read 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 cancel the provisions of any other state or local law regulating construction or the <br /> performance of construction. That I am authorized by the owner of this property to perform the E1305- <br /> work <br /> 1305-work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.20 AC. <br /> AA-A- <br /> C. <br /> — \ 3 <br /> Signature Date <br /> REVISED 3/20/13 <br />