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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 />, <br />'�3 �1 ����,�- U�, <br />PROJECT ADDRESS <br />Owner <br />Mail Address <br />' �� �=� �Y C f�� ►�d � ,�u,C�� <br />nt ail Address <br />� <br />Electrical Contractor Mail Address <br />�L�����( ���� <br />State License Number <br />Proposed Use of Building <br />'..�� G/ 1 N l'.- 1- ��x,� <br />City <br />City <br />-, %� % <br />S uare Footage (If residentiai new construction, remodel or addition) <br />Number of devices (If low voltage) <br />Description of Work to Be Done: <br />_ _ T r:. - <br />s -__ <br />-�-+..--- — -- ,..� _ <br />��.�-... -.. '. �'�� li'^'�. . �.-�- �,,,� . . ': '_� <br />• �� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />�S� <br />L fa <br />City <br />� <br />��� �� <br />State/Zip <br />State/Zip <br />Phone <br />Phone <br />: � � 'IN ;•%�'"l l�ti �4' . �„1�� � c�� � � , <br />Sta e/Zip �Phone <br />2�3--571� 35�� <br />� C����% l°�: �ZJ <br />ntract Price of Work <br />Contact Person (Plan Review) <br />ti � ��, . <br />I hereby certify that I have read and examined this application and know the same to be true and <br />correcf. 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 />violafe or cancel the provisions of any other state or local law regulating construction or the <br />performance of construction. That ! am authorized by the owner of this property to perform the <br />work fpr__�ich ap ication is made and 1 comply wifh the State Contracfors Law 18.27 RCW and <br />296:200 AC. � <br />,;' , � � .._ <br />L � , � �i . iA .� / � � ��'"7 � � <br />REVISED 3/20/13 <br />FEE <br />�Z � � <br />PERMIT# <br />E+���- l�-I <br />