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11/05/2010 22 . 51 #01510 P. 001!001 <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CF-DAR STREET, EVERETT, WA 98201 <br /> 425-2578810 - FAX 425-257-8857—wvwd.everettwa.arg <br /> ?� w <br /> PROJECT ADDRI=SS <br /> Owner Mail Address <br /> City State/Zip Phone <br /> City 6tatefzip Phone <br /> Tenant Mail Address <br /> to l moi' . --' 01,Zt/ <br /> State/zip Phone <br /> Electrical Contractor Mail Address Ctty <br /> State License Number Contra 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) aJ <br /> Description of Work to Be pone; <br /> FEE <br /> e� <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 /0 <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 co struction. That I am authorized by the owner of this property to perform the _r 1 <br /> work for which lication is made and I comply with the State Contractors haw 18.27 RCW and v <br /> 296.200 WA <br /> a re ate <br /> V1SED 3:{0113 <br />