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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 /> 191 L�L_( <br /> PROJECT ADDRESS <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address City State/ZipPhone <br /> Ll-z� �13 �3 <br /> L I J, -1 Ql z2 <br /> lect cal Contractor Mail Address City State/Zip Phone <br /> A di y 1�--a a,,I Z el-j �__90 <br /> tate 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: 1 ,l_( L t/t t 9C k d -LN A( e— <br /> �t , <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 SC) 00 <br /> l hereby certify that l 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 I <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> Sig re D to <br /> REVISED 3/20/13 <br />