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0 • <br /> 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 /> PROJECT ADDRESS <br /> Owner Mail Address City State/Zip Phone <br /> � rYl�'1�y✓mi(�G�to �(lr(�d� �62UC� 'Z� � �^� y1� 6ieq op" <br /> Tenant Mail Address City State/Zip Phone <br /> �eiNyno y"�S�s�cr�s 1'�6i0 , c�r�� �aari� . 6/11930M <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> 61�b'D'An A 4 2,A )Lt 12 b <br /> State License Number Contract Price of Work <br /> S G <br /> Proposed Use of Building Contact Person (Plan Review) <br /> Square Footage(If residential new construction, remodel or addition) <br /> Number of devices(If low voltage) <br /> Description of Work to Be Done: e,y1 r-1--(/Yy. C �� <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> /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 PERMIT# <br /> violate or cancel the provisions of any other state or local law regulating construction or the x <br /> performance of construction. That/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 /> Si ature Date <br /> REVISED 3/20/13 <br />