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• <br />• ��✓� <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 />�\32 ��c�`� �C� ��C < f�t�1 � <br />PROJECT ADDRESS <br />��c�'� ,,, C�^� ��Z lC �1hr��- 5���� <br />Owner <br />Tenant <br />Mail Address <br />Mail Address <br />� � � r, �,.� <br />City <br />City <br />�, C.,, ��5(. 2C�`� C� <br />State/Zip <br />StatelZip <br />^ <br />��:c�� <br />Phone <br />Phone <br />5ha,�.�.^� t�.����� �'� �,�` ���. s'� -� �� � s �� i�-`��1 S�,n�t���� `i ��33 <br />ic- o u�,r 5 r� t ��.: <br />Electrical Contractor Mail Address City State/zip �4 2� .� �i one� <br />_ <br />� �� �� �� � C � �i S � 6"� `.� <br />State License Number <br />p� � <br />y �c�:���1�'� � v�'1 � <br />Proposed Use of B ding <br />��1,�� 5 ��� <br />Square Foo age (If residen �al new construction, remodel or addition) <br />Number of devices (If low voltage) <br />� i <br />Description of Work to Be Done: <br />�i t �,.i ��'I/ � � �L � � v'1 � ` <br />_�Lv"l�L <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />� � �;�� .� <br />, <br />Contract Price of Work <br />Contact Person (Plan Review) <br />1 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 />--- ��/-z � f "v-- <br />Signature <br />REVISED 3/20/13 <br />FEE <br />��'l��J <br />� <br />PERMIT# <br />E l/�1 ��l-(�� ; <br />