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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 />�I Z-I �f �q���r--1 <br />PROJECT ADDRESS <br />��L1 'i�t �i-t� 4SZZ2 S 12 0 � � oe..� �)JA--- Gi � ( � � <br />Owner Mail Address City State/Zip Phone <br />5�.��;� b�� � f �'h o <br />��u � �� N� �, �� � �6 �� <br />Tenant Mail Address City State/Zip Phone <br />�� ��c�)' <br />Electrical Contractor <br />State License Number <br />i�Psfi�ti-�/� �"z���'?�t <br />Proposed Use of Building <br />Mail Address <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />Description of Work to Be Done: <br />City <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />State/Zip <br />���i <br />Contract Price of Work <br />Contact Person (Plan Review) <br />I hereby certify that I have read and examined this application and know the same to be frue 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 fhe provisions of any other state or local !aw 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 />nature <br />REVISED 3/20/13 <br />Phone <br />FEE <br />5 7 `��cJ <br />PERMIT# <br />E(���—c��� <br />�. <br />