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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 />i. i �4 Y �� <br />Owner <br />�\ ( <br />Tenant <br />�� c �/���,- <br />Electrical Contractor <br />� -J <br />33�2 <br />Mail Address <br />Mail Address <br />y 5 � `i �1; s1"r� <br />Mail Address <br />��"I �. L G,� �' Ci "Z � -1 C- <br />State License Number <br />�jl/� v� �lo � 5 �/c� ��1` ��C E <br />Proposed Use of Bui ding <br />Cz �/, � <br />Square Footage (If residential new construction, remodel or addition) <br />� <br />� <br />Number of devices (If low voltage) <br />Description of Work to Be Done: <br />G �'I � �' �Y �� (l Ci � <br />/7�C�� � G�1 ��� <br />�e l`�S r �1 _ _ G' <br />c3 Ud� � ��� �`� ,j�c� S <br />c; ✓ <br />_S� ; ��� �-� � <br />StatQ/Zip <br />/� <br />State/Zip <br />�.., lL.-i� Li�� 3� <br />State/Zip <br />� <br />�, S'�U <br />, <br />Contract Price of Work <br />Contact Person (Plan Review) <br />� <br />Phone <br />Phone <br />�f�G --7j ) ' Ic� �'l, <br />Phone <br />r <br />�,s Gv"✓� <br />� Wo <br />FEE <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 i�� � v <br />✓ <br />I hereby certify that I have read and examined this application and know the same to be true and <br />correcf. All provisions of laws and ordinances governing this type of work wil! be completed <br />whether specified herein or not. The granting of a permit does not presume to give authority to PERMTT# <br />violate or cancel the provisions of any other state or local law regulating construcfion or the �,/''� �j <br />performance of construction. That I am authorized by the owner of this property to perform the E�� � �J �' Z✓� <br />work for which a(cation is made and I comply with ihe Stafe Contractors Law 18.27 RCW and <br />296 _-WA � <br />��- �G _� _ � '3 <br />re <br />REVISED 3/20/13 <br />