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n <br />LJ <br />ELEC�'RI�AL PERfVIII" �4PPLICAI'ION <br />CITY OF EVERETT PERiVIIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />v i•)1'1 � <br />_ f Z`� M � i�1So�1 � � <br />PROJECT ADDRESS <br />�`��qf�1 a�4U � �� �� � Z�� �,� �n� oN ��; �� �✓��r� �v � � � �2� � <br />Owner Mail Address City State/Zip Phone <br />Tenant <br />�Gv,��� <br />Electrical Contractor <br />State License Number <br />Proposed Use of Building <br />Mail Address <br />Mail Address <br />V��� (�J l� L L �' %�1 � �) ��t � <br />Square Footage (If residen ial new construction, remodel or addition) <br />Number of devices (If low voltage) <br />City <br />City <br />State/Zip <br />State/Zip <br />Contract Price of Work <br />Contact Person (Plan Review) <br />Description of Work to Be Done: _ M p�} i(�L j��f fz{�riii� �LI ��-�� 1`( c'jvZ� .�,� �,()EL' <br />A.� M�1�1►'�'� fJ2y'�� �U� 7 � <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />( hereby certify that I have read and examined this application and know the same to be irue and <br />correct. All provisions of laws and ordinances governing this type of work will be compleied <br />whefher specified herein or not. The granting of a permit does not presume to give authority to <br />violate or cancel the provisions of any other stafe or local law regulating construction or the <br />performance of construction. That l am authorized by the owner of this property to perform fhe <br />work for which application is made and 1 comply with the State Contractors Law 18.27 RCW and <br />296.200 WAC. �� <br />G�'.-�,?.- <br />REVISED 3/20/13 <br />FEE <br />� � ��� <br />PERMIT# <br />E I >L�? - D � i <br />Phone <br />Phone <br />