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ELECTRICAL PERMIT APPLICATION <br />� <br />1� 3� <br />PROJECT ADDRESS <br />/ �.// � , � <br />Owner <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 />Mail Add <br />� <br />City <br />� �� <br />State/Zip <br />Phone <br />���� <br />Tenant Mail Address City State/Zip Phone <br />,��2�1�'i .,�f �;-���� %����� � � <br />Electrical Contractor Mail Address City <br />�����v�s����� <br />State License Number <br />t � � <br />�, i � 7 �' %� �� ,�Z �z� <br />Proposed Use of uilding I`� � �� � v!�� <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />�i , � <br />Description of Work to Be Done: (i� /� �'�✓� � �` <br />,� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />��� ��� ; <br />State/Zip <br />���d� <br />Contract Price of Work <br />Contact Person (Plan Review) <br />c=i f 'G�Z �` � -..._ <br />I hereby certify fhat ! have read and examined this appiication 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 fo give authority to <br />violat ancel the provisions of any other state or local law regulating construcfion or the <br />perf rmanc of construction. That 1 am authorized by the owner of this property to perform the <br />wo for whi h application is made and ! comply with the State Contracfors Law 18.27 RCW and <br />29 .200 W C. <br />c <br />� c�-��-- /� �� �� <br />ignature Date <br />REVISED 3/20/13 <br />��} -- <br />Phone <br />/�� ���� <br />� �� ���� <br />FEE <br />PERMIT# <br />E��(�� � `��� <br />