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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 />/l �� (%%�%LGC��I�/,.�lJ�/ Gl,r G��/�G v� ��� <br />PROJECT ADDRESS <br />Owner <br />Tenant <br />��1 <br />Mail Address <br />Mail Address <br />Electrical Contractor Mail Address <br />� `1��� :� 1 �l�c <br />State License Number <br />Proposed Use of Building <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />Description of Work to B� ne: % <br />' `��� `�� � �; � <br />City <br />City <br />� <br />C ity <br />'► � ��l �v��,Z-v�`�a <br />� State/Zip Phone <br />State/Zip Phone <br />0�/`1� <br />���� ���?.i-�$�� <br />State/Zip <br />�`37� <br />Contract Price of Work <br />Contact Person (Plan Review) <br />�� � d�f�� l�o�/,��,� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby certify that I have read and examined this application and know the same to be true and <br />correct. All provisions of laws and ordinances governing this type of work will be completed <br />whether specified herein or not. The granting of a permit does not presume to give authority to <br />violate or cancel the provisions of any other sfate or local law regulating construction or the <br />performance of construction. That I am authorized by the owner of this property to perform the <br />work for which application is made and I comply with the State Contractors Law 18,27 RCW and <br />296.200 WAC. <br />�---- <br />Signature <br />REVISED 3/20/13 <br />$-l�l� <br />Date <br />,iJ l�¢I �T ~� { J 1�_/ <br />� t <br />� <br />� <br />� <br />Phone <br />FEE <br />;�,`�"- , � , <br />,� r ._ � <br />PERMIT# <br />E �r' ��¢�__�;� � ��� <br />