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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 />1 � �� � �rb� � ,� fl � � .� <br />PROJECT ADDRESS <br />Owner <br />Tenant <br />��n�-�;� �� <<� <br />cal Contractor <br />Mail Address <br />Mail Address <br />Mail Address <br />� <br />,� ,�'' /l,� �' � L- <br />St e Lice se Number <br />Proposed Use of Building <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />City <br />C ity <br />City <br />State/Zip <br />State/Zip <br />Phone <br />Phone <br />L�� �� �l.'� <br />lG' ` 1 � `� <br />State/Zip Phone <br />� 6 `�- <br />Con ct Price f Work <br />Contact Person (Plan Review) <br />Description of Work to Be Done: �,h. � y,� �!� � �• ��i �, v�%�% "j <br />� s� � ;1 , � n <br />�. f_ � � 1r'� <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. AIl provisions of laws and ordinances governing this type of work will be com�leted <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 ! am authorized by tlie owner of this property to perform the <br />work for which application is made and I comply with the Stafe Contractors Law 18.27 RCW and <br />296.200 WAC. <br />na <br />REVISED 3/20/13 <br />FEE <br />5 0��' <br />PERMIT# <br />E��io-v�� <br />,� <br />