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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 />.56 0/ S z"`° �vE E vE R� r�' , u/ � <br />PROJECT ADDRESS <br />Owner <br />Tenant <br />Mail Address <br />Mail Address <br />C ity <br />City <br />State/Zip <br />State/Zip <br />Phone <br />Phone <br />I✓fru�sr Ec��7a�� s B9i� 13� ��. S� A/Ewc�s�cF �lf3�59 av6���y <br />ElectriCai ContraCtor Mail Address City State/Zip Phone <br />��/�rA/� S q�2 J� <br />State License Number <br />Proposed Use of Building <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />Description of Work to Be Done: P� IVi �.. R E �PtA c.� ME �v T <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />��� <br />ontract Price of Work <br />Contact Person (Plan Review) <br />1 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 completed <br />whether specified herein or not. The granting of a permit does not presume to give authority to <br />violate or cancel fhe provisions of any ofher state or local law regulating construction or the <br />performance of construction. That 1 am aufhorized by fhe owner of fhis property to perform the <br />work for which appli`atio� is made and 1 comply with the State Contractors Law 18.27 RCW and <br />296.200 WAC. / <br />uate <br />REVISED 3/20/13 <br />FEE <br />1 � �� <br />PERMIT# <br />E ���tl-1�� <br />