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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 />1I � v t� �� d/ U/� S G r7 «� �!-v <br />PROJECT ADDRESS <br />:S� <br />Owner <br />� <br />Tenant <br />Mail Address <br />Mail Address <br />City <br />City <br />�51� <br />Phone <br />State/Zip Phone <br />�/� �•-- <br />�� /� ,�/ <br />���?'"S.Si`c.�,� � ���C'� �"• �- /'��la � ��`� /�i'��. �-� �. �� �'/" G� f�-.� > � v -i'. k� c <br />ElectfiCal Contractor Mail Address City State/Zip Phone <br />�'/t v/'���� 7 ���-1 <br />State License Number <br />� � � ,�' �y �� <br />Proposed Us of Building <br />/C% C'<i' U <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />� <br />S -f -ocr�`� �J <br />Contract Price of Work <br />Contact Person (Plan Review) <br />Description of Work to Be Done: ✓,�f �'.�� � ,� r /d o�� e %�`f ��,L; �� _4"� ��- E� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <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 complefed <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 authorized by the owner of this properfy fo 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 />u re <br />REVISED 3/20/13 <br />� <br />Date <br />FEE <br />� 2 � �o <br />PERMIT# <br />E131f-I�`� <br />