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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 /> 2015- )_I "'A'�r,\"r� A o c 1_vie �4 �% w j <br /> PROJECT ADDRESS <br /> ff�cuc-e- --Lc,-,, 4AC- Z&L� H, (A, lanj� ALje- E)Err- W- A q�-32D t <br /> Owner Mail Address City State/Zip Phone <br /> N) 1.A- y zs-LS�3 y 0 5 <br /> Tenant Mail Address City State/Zip Phone <br /> Nory-\6 fjc"(- <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> State License Number Contract Price of Work <br /> R - Z <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) <br /> Description of Work to Be Done: t- ,`f\ Ci-Il be ;V <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> l 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 I am authorized by the owner of this property to perform the E <br /> work for which application is made and l comply with the State Contractors Law 18.27 RCW and 1 <br /> 296.200 WAC. <br /> ,may <br /> 7 - ) - <br /> Si nature Date <br /> REVISED 3/20/13 <br />