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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 /> PROJECT ADDRESS <br /> S <br /> WY, (NZO 193-&-46 tlol�„•;�t��� Cc,,.n�c� l�(�1� 7�� �Ci1�.sfi541 �verr.� if��2c�. <br /> Owner Mail Address City State/Zip Phone <br /> li,I WNk� 1i.D i s 7� Si Si C�t,� ij v�d� P w a 2 <br /> Tenant v Mail Address City State/Zip Phone <br /> byfy ACrk .1� �:., ,x�z�4 GI3�`1�ZC3 (y7�1€�7v-2032 <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> V;h 4- E i 9 co), 3) -25 Z <br /> State License Number Contract rice of Work <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: 0n a? C �PS - i anc� USPS—Z xo <br /> Srahvw►�4. . � ��c.•s <br /> i r _ <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 I O 2� '?g <br /> 1 hereby certify that I have read and examined this application and know the same to be true and ` U O <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 /1 <br /> performance of construction. That I am authorized by the owner of this property to perform the E 13 0 9 — U Z <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 />