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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 /> 25-1(0 vi Zvi / <br /> PROJECT ADDRESS <br /> /'lusrr rnsli L4,0 O (1i N <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> �• /EWIX6-0 v •r nett (Aft 33Z1 I32 ST Ste/ 12(A/ re 79o87 <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> (ET l Odd Sc_ <br /> State License Number Contract Price of Work <br /> 5FL <br /> Proposed Use of Building Contact Person (Plan Review) <br /> 3. 'a <br /> Square Footage(If residential new construction, remodel or addition) <br /> Number of devices(If low voltage) <br /> Description of Work to Be Done: W 1,--g ./UJ i..l Ho use <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 20 OD <br /> /hereby certify that/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 3 0 I <br /> performance of construction. That I am authorized by the owner of this property to perform the 155 <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> �.— -2 7-13 <br /> Signature Date <br /> REVISED 3/20/13 <br />