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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 />�� � �� .�� � <br />PROJECT ADDRESS <br />�,' Y �---C" S�vt.� ��C �"' � � J 7��Gw�c���G� /��4 . �!/ci�- L��,�, lC� —'G` � <br />Owner Mail Address City � State/Zip Phone <br />. `` <br />�--� � . <br />�� C / i GC �!/1G"Guls <br />enant <br />Electrical C <br />� ` <br />,, � '� y--- � � ; � � <br />Mail dress �� City <br />�, <br />� /a�L � <br />Mail Address <br />�-'�C//l/��/ ����� <br />State License Number T <br />�--�'S4f�c� /Gr/��'Y'�� /�LdzISC� <br />Prop d Use o, Building <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />City <br />State/Zip <br />� %��/-r� /� <br />State/Zip <br />� � �dU "'° <br />Contract Price of Work <br />L"� Gt�v7 ��Gj�2�i! <br />Conta t Person (Plan Review) <br />Description of Work to Be Done: �G� v�" U-�.�T=r �r� •�~ S' 1��� ��!�"� <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 state or local law regulating construction or the <br />perfo�mance of construction. That I am authorized by the owner of this property to perform the <br />work for which application is made and 1 comply with the State Contractors Law 18.27 RCW and <br />296.200 WAC. <br />REVISED 3/20/13 <br />Phone <br />Phone <br />FEE <br />.�l.i��� <br />PERMIT# <br />E�>��; ����.1 <br />