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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 /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> 771,lec ��G l �-►%l�s 2G �' l5 tA ur Sid e ��ut�� 30o7 206 YX-f14 <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> 77FLFES93o U 0c) <br /> State License Number (� Contract Price of Work <br /> Proposed Use of Building Contact Person (Plan Review) <br /> Square Footage (If residential new construction, remodel or addition) <br /> Number of devices (If low voltage) <br /> Description of Work to Be Done: �QU-A—L—Q� <br /> 1G � <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 ! v <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 <br /> performance of construction. That/am authorized by the owner of this property to perform the E <br /> work for which application is made and/comply with the State Contractors Law 18.27 RCW and <br /> 296.200 <br /> 30/30/? o13 <br /> Signature Date <br /> REVISED 3/20/13 <br />