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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 />. �l � ^-��—� ,/� <br />� 1.��.�� — 1\ \ ,` l__ �1,��� 1�1� �/C�' . <br />PROJECT ADDRESS <br />_�7� �i�'��.,/ �_� � ,� s _ �6 : -�t -� Jw�� � � �/� � '�;�; • � i W � ��c :�U ( �'' <br />Owner Mail Address City State/Zip Phone <br />Tenant <br />Mail Address <br />City <br />State/Zip <br />Phone <br />� �r �'� �1��'� lla�.!'—r��t� ���Ox / ��JG ` 1rk � i� l/ f 'n' �CJ �J %-� ye��"� % ��i <br />Electrical Contractor Mail Address City State/Zip Phone <br />.� �i � �1. it/C i C �7 i �" � <br />State License Number <br />/ � <br />7 �^_ ,` <br />Proposed Use of Building <br />'CJC� d � .� <br />Square Footage (If resi`dential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />Description of Work to Be Done: <br />- r✓ 'r7 � � ��i'�/fri .�� .• - ; <br />�, <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />���� ��' <br />Contract Price of Work <br />�< �7— <br />K�.`G�rc% ,[T' �.'�=) J��� <br />Contact Person (Plan Review) <br />l hereby certify that I have read and examined this application and know the same to be frue 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 fo <br />violate or cancel the provisions of any other state or local law regulating construction or the <br />performance of construction. Thaf I am authorized by the owner of this property to perform the <br />work for whic p,qlication is made and I comply with the State Contractors Law 18.27 RCW and <br />296.200 W C. <br />� - . �� /�/_a i� � /� / � <br />re <br />REVISED 3/20/13 <br />FEE <br />�U �0� <br />PERMIT# <br />E �v��?-�I� <br />