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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 /> L,rUc� cJr77- <br /> AV e <br /> PROJECT ADDRESS <br /> 4zS <br /> S�z c ou N rti �"p /V Q L 7S" SZ22 S2 C v(,/1.P 7 �S z0 l S 3— <br /> Owner Mail Address City State/Zip Phone <br /> 5,10 PU 7-5—a-> f(r&Vt 77 ,400 Iz i,eA,-17 1'./9 `7 �-2'0/ <br /> Tenant Mail Address City State/Zip Phone <br /> I�iPFi'C�9 "F>ry,y f.�Nl�,,,,>QlJ � �v i,✓ -jt" "ACV 4M C 410 25-1 97v-31cv <br /> Electrical ontractor Mail Address City State/Zip Phone <br /> AEr--/Z.7 u -TS 75 PA /ssza Cao <br /> State License Number Contract Price of Work <br /> rrF-<-e 13 <br /> Proposed Use of Building Contact Person (Plan Review) <br /> Square Footage(If residential new construction, remodel or addition) <br /> Number of devices(If low voltage) n /� <br /> Description of Work to Be Done: <br /> FEE g� <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 �—o D <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 PERMIT# <br /> violate or cancel the provisions of any other state or local law regulating construction or the <br /> performance of construction. That 1 am authorized by the owner of this property to perform the E1402- - <br /> ^ <br /> work for which application is made and 1 comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> Sig a Date <br /> REVISED 3/20/13 <br />