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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 /> ;q <br /> PROJECT ADDRESS <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> FD <br /> Electrical lontractor Mail Address City State/Zip Phone <br /> R122 --mj <br /> State License Number a Contract Price of Work <br /> a-A <br /> Proposed Use of Building Contact Person (Plan Review) <br /> �6rC) <br /> Square Footage (If residential new construction, remodel or addition) <br /> Number of devices (If low voltage) i <br /> Description of Work to Be Done: ����rA_ 1 CQ C✓N V A 00 <br /> c?q <br /> L <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> i hereby certify that l 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 <br /> performance of construction. That/am authorized by the owner of this property to perform the E i Jr <br /> 3 <br /> work for wflich application is made and/comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> Signatur ' Date <br /> REVISED 3/20/13 <br />