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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 />�-1 �� � �i k���, I�i � <br />PROJECT ADDRESS <br />Owner <br />Mail Address <br />City <br />State/Zip <br />Phone <br />�R <br />(� I-�- � (�c�-� � -�c;� �2:i � � �">,�� `� �,�� �1T �,.; � ��� -- � �� �; <br />Tenant Mail Address City State/Zip Phone <br />�i�'�-S, h` � ��i"��iC��. �`� �� �h�x �r`�1�.� �=���` "�T ��J�C� � 2-� j <br />Electrical Contractor Mail Address City State/Zip Phone <br />�� ��� �= c���� � P � <br />State License Number <br />�� I� � = �i '�� � _ <br />Proposed se of Building <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />,-�� <br />:��,��� <br />Contract Price of Work <br />Contact Person (Plan Review) <br />G�-1T�' �� � I C_� ��`�� <br />��-1 � :� ) C�; _� <br />1-- <br />Description of Work to Be Done: =N'_7 � 1'� L„�.. �z �" t��-"� '�--) �== �'"�' � ti� ��- <br />r� ;� �. c� � � �% G�:� � L �� ,� �.: _ c��� � �. �:..-,- -r�� �v. i S•-; ; ,J� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />l heredy certify that I have read and examined this applicafion and know the same fo be irue 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 <br />violate or cancel the provisions of any other stafe or local law regulating construction or tl�e <br />performance of construction. That I am authorized by the owner of this propeity to perform the <br />work for which ap t�on is made and I comply wifh the State Contractors Law 18.27 RCW and <br />296.200 WAC. � / <br />�`_ <br />Signature <br />Date <br />FEE <br />��I n� �� <br />�!G 8 <br />PERMIT# <br />EI�12--'�'�I <br />0 <br />