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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 />3�3z c��� � � <br />PROJECT ADDRESS <br />�? <br />G I���-� ��, �6 U�x �3 �3 a �� �� �� ������ w.� q������ <br />Owner' Mail Address City State/Zip Phone <br />b�� <br />Tenant <br />Mail Address <br />City <br />State/Zip <br />Phone <br />�� �L � <br />.S[�11r1��i�-�'i�'�^�ne�a��5 /�'i2/ Ev�?rC�('et',� ��✓y�2gL �,U�rt'�` `���1 �%iG7 �'i�'i3� L- <br />EleCtfical Contractor Mail Address � City State/Zip Phone <br />S �� ��� �, !'"-� �� i���; 2 <br />State License Number <br />�; , (,� � �� �- � a �R- <br />Proposed Use of Building <br />Square Footage (If residential new construction, remodel or addition) <br />�n <br />Number of devices (If low voltage) <br />,�OC���� — <br />Contract Price of Work <br />��G� ������ �� <br />Contact Person (Plan Review) <br />Description of Work to Be Done: � � c ;�� � � � G� �' ,i' ��C� r �� � �� vl � <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />! 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 wil! be completed <br />whether specified herein or not. The granting of a permit does not presume to give authorrty to <br />violate or cancel the provisions of any other state or local law regulating construction or the <br />performance of construction. That I am authorized by the owner of this properfy to perform the <br />work for which applicafion 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 />/� _�/-)� <br />uate <br />FEE <br />��-�� <br />PERMIT# <br />E � �� �- -� D�� <br />