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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 />� �'' � � �3 � d��,e��"� ����! <br />, <br />�r �—.� _ %� G'l F::G' -� <r�"''� f: _ . ,� ,'. o� <br />. � � <br />PROJECT ADDRESS <br />.�.-�, il�� D.,�n -� � .,� �, : ; � � �� , � ( � � I 7 <br />� u"'C..i.� 'f._._� A ,��. .�,� _r' .�C , A � ��.j <br />+ <br />Owner Mail Address City State/Zip Phone <br />Tenant <br />Mail Address <br />��f t' f, �.'. ! '% Yr;, �" �':t, <br />ETrical Contractor Mail Address <br />.r; r 1 , <br />State License Number <br />�. i <br />Proposed Use of Building <br />:a�, ; � <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />Description of Work to Be Done: �� � <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />City <br />. ; ; ,, <br />C ity <br />State/Zip <br />i.1 _��4 �, <br />State/Zip <br />Contract Price of Work <br />Contact Person (Plan Review) <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 authorify to <br />violate or cancel the provisions of any other state or local law regulating construction or the <br />performance of construction. That 1 am aufhorized by the owner of this property to perfonn the <br />work for which application is made and 1 comply with the State Contractors Law 18.27 RCW and <br />296.200_ WAC. <br />� <br />REVISED 3/20/13 <br />Phone <br />Phone <br />FEE <br />� � <br />�� -�'_ � <br />ii:�y'�� � c,��`;, <br />PERMIT# <br />E 11 � r� ,� .,- 1-�a Ir-, <br />V � <br />