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ELEGTRICAL PERMIT APPLICATlON <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 /> ZC�Cc,<<i ;h c� ,��� ����'f �-'� <br /> PRO ECT ADDRESS <br /> 7 i� <br /> `���� �(� `�4z� I� ��-. 'w' ���r�f L�--�1 �I��04 s�'1431��Cz <br /> Owner Mail Address City State/Zip Phone <br /> ' � �r S �� � <br /> V 1 S 1��� �%��L l,{��'� 7�-�'����-�S i�r v �c ���9��1� l,�-/'� �l�i C <br /> Tenant Mail A dress City State/Zip Phone <br /> �U[..hPi/�� �O�L%hi��C�C�,�, <br /> Electrical ContraCtof Mail Address City State/Zip Phone <br /> k�, 1C��'c' `� <br /> State License Number Contract Price of Work <br /> C;�"1 Lt(���� Q iN i'l�' <br /> Proposed Use of Building Contact Person (Plan Review) <br /> Square Footage (If residential new construction, remodel or addition) <br /> Number of devices (If low voltage) <br /> Description of Work to Be Done: �r �Dcc�-��j U��� ��e� �-lv� �� S��i ��C V\ + /�,'�?�t�i �7��'�t c���t� S�i_, ��:,{��,.� <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 'i� �"J� <br /> __— <br /> I hereby certify that 1 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 nof presume to give authority to PERMIT# <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 E �3,�5 _ � � <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296:2001?VAC. <br /> �"� � � <br /> � �;�_- � , <br /> � <br /> � -�� _ <br /> __--_ ______ �����:.�� 1�, 7C�i�� <br /> �gnature Da� <br /> REVISED 3/20/13 <br />