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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 /> V L\ <br /> C�PROJECT ADDRESS <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> 77 Ffocfr;cal uaa �WQ1��fh ll��t c S �e`f� vile- c.r% �j c 7 706 Sry l��i <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> State License Number Contract Price of Work <br /> Propo ed Use of Building Contact Person (Plan Review) <br /> Square Footage (If residential new construction, remodel or addition) <br /> v <br /> Number of devices (If low voltage) Z6� <br /> Description of Work to Be Done: l� ��/l^ //I v�� > " <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 G C <br /> 1 hereby certify that 1 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 U <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> iz- //- 20 f3 <br /> Signature Date <br /> REVISED 3/20/13 <br />