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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 />� J U .� h� �,�3 �. v �-f—� <br />PROJECT ADDRESS <br />��xr�.� 1 � � .� ���tt� ��c , � � �t � n��t� �,� w� , s� ��� � � �� ���,� ��- �z ��:�� <br />Owner Mail Address City State/Zip Phone <br />�Ic�l^,��t�, (x.��,r- �r �i��� ht�,��,�;�"" "�3�5 ��.l��� `.�� Cvzn,t�� � �.3vo i <br />Tenant Mail Address City State/Zip Phone <br />���re�,^zet� ��-rq:,r��"t-i=�� �Z7 �,�#'h l•tw���-► St • j�C ��✓!k ��31 ��� "?,�•� �h3 - l�yy <br />ElectriCal Contractor Mail Address City State/Zip Phone <br />����'�(�'�I.�s�Z�' f3 <br />State License Number <br />Proposed Use of Building <br />Square Footage (If residential new construction, remodel or addition) <br />`� � <br />Number of devices (If low voltage) <br />Description of Work to Be Done <br />��{a,�l.�-���, v� .-��,�„r- � �--f <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />f� 7 �iU _ l� <br />Contract Price of Work <br />��� ������ <br />Contact Person (Plan Review) <br />I 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 <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 <br />work for which application is made and 1 comply with the State Contractors Law 18.27 RCW and <br />296.200 WAC. <br />gnature <br />REVISED 3/20/13 <br />�-/2�/l�t <br />FEE <br />�� <br />PERMIT# <br />E j��`�—j�5 <br />