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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 />i� � � <br />�'� �� c,C�� �L vL <br />PROJECT ADDRESS <br />(���S�G <br />Owner . ( <br />1 1 ��G1�7�.�� <br />Tenant <br />��r �ail Address <br />�-�' .� <br />/�'�� ���L�1-�� <br />Mail Address <br />�,�h� �� i��� L. ��, h� n� �� <br />Electrical Contractor ail Address <br />.a <br />� <br />C l i��G .r� � i�� ���z�,,�s <br />State License Number <br />Proposed Use of Building <br />City <br />�j ) I <br />1�- ; � V� � � L- �� <br />City <br />���7 ���l,n�Jz <br />City � <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />Description of Work to Be Done: <br />�'? G r/� n � o� � �C- � <br />G� iC ��� �� � r} C'� rti1v� e <br />�, , <br />� L , a �,�.,� <br />State/Zip <br />�L,/ /�j <br />State/Zip <br />Phone <br />Phone <br />�G . ���, z �� ��-�.,y� y _�� � <br />State/Zip <br />Phone <br />��� �'� '._.- <br />Contract Price of Work <br />� �'�; , � % G� c� �� �; '-� <br />Contact Person (Plan Review) <br />�� �� c s <br />� � <br />�� c� �; � L� rh m�' �'� C� (��„� S <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <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 goveming this type of work will be completed <br />whether specified herein or not. The grantrng 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 pertorm the <br />work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br />296.200 WAC. <br />n <br />REVISED 3/20/13 <br />�-�._i-13 <br />FEE <br />zlz�� <br />PERMIT# <br />E I ��� -��-� <br />