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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 /> F vr�t--- <br /> PROJECT ADDRESS <br /> -7 Q <br /> ice' ( - k//' /9 I <br /> Owner Mail Address City State/Zip Phone <br /> / <br /> I <br /> Tenant Mail Address City State/Zip Phone <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> 77)e Lim C-SC?3 D tL,C <br /> State License Number Contract Price of Work <br /> Proposed Use of Building Contact Person (Plan Review) <br /> 2_�G _�J`-�t ( L4- <br /> Square Footage (If residential new construction, remodel or addition) <br /> V <br /> Number of devices (If low voltage) <br /> Description of Work to Be Done: C)c) <br /> ,(ZV" 1p�(� 2 C►� c 7 �d �O Gwt1 c ^ i�, (-- <br /> YO <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certify that I have read and examined this application and know the same to be true and9090 <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 E ) 3 3 �./ t <br /> work for which application is made and i comply with the State Contractors Law 18.27 RCW and t <br /> 296.200 WAC. <br /> 16, 20 i 3 . <br /> Signature Date <br /> REVISED 3/20/13 <br />