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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 /> PROJECT ADDRESS <br /> Owner Mail Address City State/Zip Phone <br /> & /f � 920 <br /> 6 �'v2rc'7�7� '--i/j 7'y2c( <br /> Tenant Mail Address [� /City State'/Zip Phone G <br /> 6naL t - ify P 6 -�/ �`�61 <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> State License Number Contract Price of Work <br /> df!C.�-' ( <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: .y/V r��[ 76-1C Cd„+Yi/'�a��ryT� i`ti /d /)�n'dc' r <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 "~ �� �j ✓ 7 D <br /> I hereby certify that l 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 l 12-1 performance ofconstruction. ThatI am authorized by the owner of this property to perform the f <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> Signature Date <br /> REVISED 3/20/13 <br />