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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 />'1 ��: � :� �: ` : . , :_-. �- <br />PROJECT ADDRESS <br />r �`� � <br />;, ��:_,- <br />, _ �, <br />.� , � � J ,_,: � � ���: � . . <br />�A� �=�� �� 1 , �=' �� t-, � ��� J �-I l �<���.c1:�;<� � ��v�- � �� F�� 1,� ��, � , � - I�.>� � <br />Owner Mail Address City State/Zip Phone <br />T <br />Mail Address <br />,: < <br />�1 l,- i\ �`�;�t.) _ � <br />City <br />State/Zip <br />Phone <br />�C <br />.� I -� e — � � �� � �{� 1�;� � r��� ��-. �. �1 "� c - i � k � <br />... , , , , r <br />_ � <br />�� � � ` , , , Y. . ; _, � . 1 ,a, . � �1 , �: . <br />�_ <br />Electrical Contractor Mail Address City State/Zip Phone <br />�:L`�-t ��- e � �_= � ; � i<- �.. . <br />State License Number <br />���-� �L \ _y- � .y,�-.�.�_, �__.; �_ �i <br />Proposed Use of Building <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />�� �� � � le �� ��. <br />Contract Price of Work <br />,-- � <br />�, _.-,._ (�. -� t. ! 0, <br />Contact Person (Plan Review) <br />` l � <br />Description of Work to Be Done: y � . � ���t � � � � ��_ ' ; � � x 1 �a -�� -�`� ��� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby certify that 1 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 <br />violate or cancel the provisions of any other state or local law regulating construction or the <br />performance of construction. That 1 am authorized by the owner of this property to perform the <br />.vuorf� which application is made and 1 comply with the State Contractors Law 18.27 RCW and <br />i 296.200 WAC. <br />���' �,� , �. ��� � � I �-1 <br />�) <br />Sign <br />REVISED 3/20/13 <br />Date <br />FEE <br />�U <br />�� � <br />PERMIT# <br />E C���- r�� <br />