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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 />J � � ;,�v c �C' ✓ <br />PROJECT ADDRESS <br />j c>/r � ���" / l S � / �� cic ��-' /�v P�'��� L�� �-/ �.�r' � <br />Owner Mail Address City State/Zip Phone <br />Tenant Mail Address City State/Zip Phone <br />�/1 � <br />�,''�7�Pss� of��� �`�lc /%� ��� c l�'G� 1J � f�j ./��✓•�y �� l.�J/� G✓�"Jv�� 3�v-.1 ,� <br />ElectriCal ContraCtor Mail Address City StatelZip Phone <br />�,� � ��✓— � �G�G-� % I �� <br />State License Number <br />/� c� f���l t�G � c: if' <br />Proposed Use of Building <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />Contract Price of Work <br />Contact Person (Plan Review) <br />i .� <br />Description of Work to Be Done: �i' �`fG /� J.»�'�� �,/'c ���' �-� � c,. �C,� <br />�— <br />rC�`'-G`r�G �l �' G'� `�C��/ O�F�Ii7 Cr�� O` � C�JC/�f/�/`c� G`��vT��'/� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ce�tify that I have read and examined this application and know the same to be true and <br />cor�ect. 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 state or local law regulating construction or the <br />performance of construction. That 1 am authorized by the owner of this property to pertorm 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 />Signature <br />REVISED 3/20/13 <br />FEE <br />�j O <br />�� <br />PERMIT# <br />E r ��� � o(� t� <br />