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06/28/2013 09: 46 FAX 4253538934 Evergreen Security X002 <br /> 9 0 <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-287-8810 - FAX 425-257-8857-wvvw.everettwa.org <br /> PROJECT ADDRESS n <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mall Address City State/Zip�2�^3 3�Phh000nnee <br /> Electrical Co ractor Mail AJ re Clty State/Zip Phone <br /> �V <br /> State License Number Contract Price of Work <br /> p <br /> Proposed Use of Building Contact Person (Plan Review) <br /> i <br /> Square Footage(If residential new construction, remodel or addition) <br /> lD— <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 <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 provisfons of any other state or local few regulating construction or the � au� y- 2�� <br /> performance of construction. That/am authorized by the owner of this property to perform the l <br /> work for which application is made and/comply with the State Contractors Law 98.27 RCW and <br /> 296.200 WAC. <br /> Si sture Date <br /> REVISED 3/20/73 <br />