Laserfiche WebLink
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 /> (O �a � 3 y <br /> PROJECT ADDRESS <br /> Owner Mail Address City State/Zip Phone <br /> lGK S (camUe S I: yEy� X36 �1 r`'��� �Prens tN.a- <br /> Tenant Mail Address/ City State/Zip Phone <br /> h <br /> �gc ,2S' <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> 12 C4 P1 - ,,10c- t q9-1/ 0 '-T— 3l �/ <br /> State License Number Contract Price of Work <br /> U` cJl� 4i �l�t' �� <br /> Proposed Use of Building Contact Person (Plan Review) <br /> Square Footage (If residential new construction, remodel or addition) <br /> l G) <br /> Number of devices (If low voltage) <br /> Description of Work to Be Done: <br /> FEE <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 v✓ V 11 V <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 PERMIT# <br /> violate or cancel the provisions of any other state or local law regulating construction or the --7 <br /> performance of construction. That I am authorized by the owner of this property to perform the E <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> Signature Date <br /> REVISED 3/20/13 <br />