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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 /> 12� yj o E <br /> PROJECT ADDRESS <br /> Owner Mail Address City c/'I- <br /> State/Zip Phone <br /> `C"o•r 1� � - ►411 . 120 1& 6a;i-lo 12dj6� e/ f- C4ZI9 <br /> Tenant --P Mail Address City State/Zip Phone <br /> 77 ,F'le of lt.c.,,t Se1 vi S 10 9 /S a,.,,e SE&tlot,W `.e, 4cA5207 <br /> Electrical Contractor Mail Address City State/Zip r� ^ Phone <br /> 2--V65��9/�6 <br /> -779/--'t(=7 s g 2 ?v p <br /> State License Number Contract Price of Work <br /> Proposed Use of Building Contact Person (Plan Review) <br /> d <br /> Square Footage (If residential new construction, remodel or addition) <br /> I <br /> Number of devices (If low voltage) <br /> Description of Work to Be Done: / QN? %Z$ 7�Q 1fi^�— ct AU fad ems' <br /> S CP LZ <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> /hereby certify that 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 cr 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/am authorized by the owner of this property to perform the E I Ifo l 1 <br /> work for which application is made and/comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> 7 . <br /> Signature Date <br /> REVISED 3/20/13 <br />