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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 />I�oa Sh �Jr�`�; t�Cu� ;��.n.e.tt l�J l� <br />PROJECT ADDRESS <br />Owner <br />Mail Address <br />City <br />� �vu ���-_�u r- - <br />State/Zip y�%O Phone <br />r ll,t�'F,iti�(� ;�ll� , l F�Mn'1L' n1,9°./9j7��'1/) ��. C���19�h �Z��. � i�cce�,� �?i� ��945 <br />Electrical Contractor Mail Address <br />�-u-r� mc� i c� 1 rn�- <br />State License Number <br />� � <br />i�n� . � - � <br />Proposed Use of BuiidL g <br />�x-ISGI(.�/ L�� , ��Vl./ <br />Square Foo ge (If residential new construction, remodel or addition) <br />v� <br />Number of devices (If low voltage) <br />City <br />State/Zipp�j� - <br />� c5f � ' °�) <br />Contract Price of Work <br />v�� a5 �3 <br />Contact P son (PI n Review) �) /�� <br />! ll/ <br />Description of Work to Be Done: rn,�n �LQ_,,t('g� �(� t1 (°�L?k'(�. 0 airtDA i)LL�VI yU .�L[��.Q c�(.X(��Yl <br />U � <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby certify that I have read and examined this applicafion and know the same to be true and <br />correcf. 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 />vrolate or cancel the provisions of any other state or locaf law regulating construction or the <br />performance of construction. That 1 am authorrzed 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 />v�s.a <br />REVISED 3/20/13 <br />FEE <br />�,� �'�� <br />PERMIT# <br />E ��d�-�3� <br />