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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 /> ��0501eejelL e eee i? <br /> PROJECT ADDRESS <br /> S tjbL USA s AMc A3 AQP�<<! Ao-4W4ss <br /> Owner Mail Address City State/Zip Phone <br /> 5A,4e AS pAwm- <br /> Tenant Mail Address City State/Zip Phone <br /> Electrical Contractor Mail Addr(ss City State/Zip Phone <br /> '4d0Y � #r?.S00 <br /> State License Number Contract Price of Work <br /> 0,19t'rze-5 6&A) s,n,';22 <br /> Proposed Use of Building Contact Person (Plan Review) <br /> Square Footage(If residential new construction, remodel or addition) <br /> 0 <br /> Number of devices(If low voltage) I <br /> Description of Work to Be Done: 4,0,0SMIC 66-z /y/ /O GDS�D� /1 l eo <br /> D,J �JDORJ c� 2 A/ �X lS��.✓S Di��c ri /�/�ll <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 I r -7 <br /> 1 hereby certify that I have read and examined this application and know the same to be true and l <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 it I <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and �I <br /> 296.200 C. <br /> gnatde Date <br /> REVISED 3/20/13 <br />