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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 />��� 4v !�/ <br />PR;OJECT ADDRESS <br />��lC'_ ��/q 9�� o l <br />I��A�X ,�, c.�� A�d so.n �� i�� v P I C�� <br />Owner Mail Address City <br />��5 <br />��� ��� � l �5.a <br />State/Zip <br />Phone <br />�/�me �s �bvv�= <br />Tenant Mail Address City State/Zip Phone <br />S �. � <br />Electrical Contractor <br />State License Number <br />Proposed Use of Building <br />Mail Address <br />Square Footage (If residential new construction, remodel or addition) <br />� <br />Number of devices (If low voltage) <br />C ity <br />State/Zip <br />Contract Price of Work <br />Contact Person (Plan Review) <br />Description of Work to Be Done: f�- �� I� �-'�— �� �^ �- /—/� ✓1 G� � , v� ��U r%�� <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 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 /ocal law regulating construction or the <br />performance of construction. That I am authorized by the owner of this property to perform the <br />work for which applicaiion is made and I comply with fhe Stafe Contractors Law 18.27 RCW and <br />296. 200 WA C. �---� <br />�_. <br />REVISED 3/20/13 <br />Phone <br />FEE <br />5�6�00 <br />PERMIT# <br />E (���`�`�� <br />�' �1 <br />