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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 />)S ��., C��IC� ��'�,, <br />PROJECT ADDRESS <br />����� �c���r��� C.c�-�s�'�. }�� j3c.� ) �ny 1'hccir�Sv��G� �x,y+, �� �.711 y:�S �' Jo �- ) � i <br />Owner Mail Address City State2ip Phone <br />Tenant <br />Mail Address <br />City <br />State/Zip Phone <br />s�1�s E��-��f,� ���a� 4a � S� S►,�C�:�,':��, w� ��3,`io `�as 3��H 1��� <br />Electrical Contractor Mail Address City State2ip Phone <br />s�1',s e"� Y�9 �� � <br />State License Number <br />U Z,t�i ��t i`�C�c�C L IT 0 4,�Q., <br />Proposed Use of Building <br />.� C`t. � <br />� �5��, �i <br />Contract Price of Work <br />Contact Person (Plan Review) <br />Square Footage (If residential new construction, remodel or addition) <br />rs <br />Number of devices (If low voltage) <br />Description of Work to Be Don � �I -� ��r,' �4 L �� L�� �'�1��1 Vv (�W ` � � �1,� J�1� <br />R� .��c_ �Y ��'`y 'v�;1 � l Yf i_ r J l-(�►a`c�� 1,�:, l 1' lv�� <br />:J <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />l hereby certify that / have read and examined this application and know the same to be true and <br />correct. All provisions of laws and ordinances goveming this type of work wiH be completed <br />whether specified herein or not. The granfing of a permif does not presume to give aufhority to <br />violate or cancel the provisions of any other state or local law �gulating consfruction or the <br />peiformance of construction. That I am authorized by the owner of this property to perform the <br />work for which application is made and 1 comply with the Sfate Contractors Law 18.27 RCW and <br />296.200 WAC. <br />� <br />REVISED 3/20/13 <br />ln�>> � )3 <br />FEE <br />gv`� <br />PERMIT# <br />E � � O(�,-� 7 <br />