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ELECTRICAL PERMIT APP ICATION <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 /> L1e- <br /> Owner <br /> Mail Address City State/Zip Phone <br /> Tenant <br /> Mail Address City State/Zip Phone <br /> 206- / 3 ✓ 1�� /�rrr Z�iy' `/cS�L' 7d[` 3'S'1->'G��CT <br /> Electrical Contractor <br /> Mail Address City State/Zip Phone <br /> State License Number Contract Price of Work <br /> lee tet/ /9ta /c C r <br /> �z' r Contact Person (Plan Review) <br /> Proposed Use of Building <br /> Square Footage (If residential new construction, remodel or addition) <br /> iy <br /> Number of devices (If low voltage) <br /> Description of Work to Be Done: c <br /> C�tiTr / i J' <br /> le <br /> l� r Tr � /�1 c�C':/ f ra J' ✓Yc1� ,v G �r�, %- _ <br /> C J �> <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 J <br /> 1 hereby certify that/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 r <br /> performance of construction. That I am authorized by the owner of this property to perform the t <br /> work for which application is made and 1 comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> �Li�."�}z-- AL <br /> / `�' <br /> Signature Date <br /> REVISED 3/20/13 <br />