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• <br /> 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 /> M ['I By, ,� ��, �o�t S� rw,t �✓�, ,s,� leo �t� <br /> Owner Mail Address City State/Zip Phone <br /> f7(IA— W e5lx-n 5,,,4,,. 11-22 -TyVj"'4 rj 5 F'V"-&b4-I w& `19 210 3 <br /> Tenant Mail Address City State/Zip Phone <br /> `727 <--o� kwy-p , S Iw/k L" <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> 114HD o-z--, <br /> State License Number Contract Price ofWork <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: � V��✓V�1'�� �� t:� � �r�s�� <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <35- --7-0 <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 �J <br /> performance of construction. That/am authorized by the owner of this property to perform the E C Lo I l <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296,200 WAC.x <br /> 'vt�— � / <br /> Signature Date <br /> REVISED 3/20/13 <br />