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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 />l��Z De���� ; <br />PROJECT ADDRESS <br />�:Lf•p.2c';��:-�'a.ri0. ��7�2 ��Y1 /L,'sN'i�"`.�'l' ��,i�'' �',1:..���,,: �:..: ,-.-�::�^;— <br />�--�— �;� �' at.�� , F� i4 .1 <br />Ownex Mail Address City State/Zip Phone <br />Tenant <br />Electrical Contractor <br />State License Number <br />Mail Address <br />Mail Address <br />.��"/,�/Gr P <br />Proposed se of Building <br />« ` <br />S? .S `� <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />City <br />C ity <br />Description of Work to Be Done: ��%�,�r �,�� �,,w��z,�r�� ��l' ��`rY� r:'�fC:� �'E''.� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />State/Zip <br />State/Zip <br />Contract Price of Work <br />Contact Person (Plan Review) <br />I hereby cerfify 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 he completed <br />whether specified herein or not. The granting of a permit does not presume fo 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 I am authorized by the owner of this property to perform the <br />work for which application is made and ! comply with the Siate Contractors Law 18.27 RCW and <br />296.200 WAC. <br />re <br />REVISED 3/20/13 <br />Phone <br />Phone <br />FEE <br />"/ Q �� <br />PERMIT# <br />E�i���-��� <br />