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ELECTRICAL PERMIT APPLICATION <br />CI�Y OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />_� ��C�: `°i � s"i 5tr���T F�' E i� E�rT v�a y�.��5 <br />PROJECT ADDRESS <br />Owner Mail Address City <br />State/Zip <br />Phone <br />_� v l.z. j.1 A�c.� J3 L�5 N I N C� <br />Tenant Mail Address City State/Zip Phone <br />�.�r.�rv t c�,�;�� ,v�+�� Nwes+" 13vS s� ivi� D�;se;� s� �if'��,:ti/� vvr�J 9`����s ,��,(, c:,50-1s �6 <br />Electrical Contractor Mail Address City State/Zip Phone <br />(ra u I �. b I �� �y <br />State License Number <br />Proposed Use of Building <br />Square Footage (If residential new construction, remodel or addition) <br />i �5 <br />Number of devices (If low voltage) <br />Contract Price of Work <br />Contact Person (Plan Review) <br />Description of Work to Be Done: � lV �i�T !� LL V c� tC t`�" .A li 7��(-) f; L.�4 <br />CITY OF EVERETT LOCA� SALES TAX CODE IS 3105 <br />1 hereby certify thaf 1 have read and examined fhis application and know the same to be true and <br />correct. All provisions oflaws and ordinances goveming this fype of work wil! be comp/eted <br />whether s�ecified 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 locat law regulating construction or the <br />perforrnance of construction. That l am authorized by fhe owner of this property fo perform the <br />work for which application is made and 1 comp/y with the State Contractors Law 18.27 RCW and <br />296.200 WAC. <br />i� ,�. / J y <br />Date <br />REVISED 3/20/13 <br />FEE <br />�V <br />�� / <br />PERMIT# <br />E 1�0z. ��� <br />