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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 />� Il � ��' c /�� t' <br />PROJECT ADDRESS <br />� �'� <br />/--t � i''—� �4"� � �Al� V'/� �-���,r��.�'/-� <br />Owner Mail Address <br />Tenant <br />U �%�c= %� <br />Electrical Contractor <br />State License Number <br />Proposed Use of Building <br />Mail Address <br />Mail Address <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />=� % / / �l �'�° � : r"-�� ,�' ,� t� �: <br />City State/Zip <br />C ity <br />City <br />Description of Work to Be Done: /�,/�= �= � �� ��/J� n^�' `� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />State/Zip <br />State/Zip <br />Contract Price of Work <br />�. C�`- �� e� z o3 <br />Phone <br />Contact Person (Plan Review) <br />Zc�� /1�(/J <br />I hereby certify that l 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 nof presume to give authority to <br />violate or cancel the provisions of any other state or local law regulafing constn.rction or ihe <br />performance of construction. That 1 am authorized by the owner of this property to perform the <br />work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br />296.200 WAC. � <br />, <br />% � _ G' 3 - Z "} -- l3 <br />atur�-- j Date <br />; ', <br />REVISED 3/20/13 <br />Phone <br />Phone <br />FEE <br />l � - �; C% <br />PERMIT# <br />E �3t>>-1�S <br />