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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 /> 5.7. 1/y /O f' Of. kir. f- <br /> t/e/,# 71003 <br /> PROJECT ADDRESS <br /> Du d ©/'4'46'4 d► S`7172l /U" De. w, ef1 k/I, f rd a 3 <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> Electrical Contractor Mail Address City State/Zip Phone <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: bfi',rin y r,l ,a he i f,b Ya f44, /7'Ilr;A P Ifes J,a'g a / pug/P/ el el <br /> addi.4y u `SOArdaov Out/f/ ; /6e i&ii ' t°, <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 .5 0 -00 <br /> I 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 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 ( ?? - <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> 7/a`/� <br /> ignatur Date <br /> REVISED 3/10/13 <br />