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� <br />u <br />ELECTRICAL PERMIT �4PPLICATION <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 />i7?UD �(I �r �7�� �-Jrf�'_�� - jtZ � �1- <br />PROJECT ADDRESS <br />Owner <br />EV�,��-f1- <br />`T l��e.," � l <br />Tenant <br />� <br />Electril�al Contractor <br />' Mail Address <br />�I�� <br />Mail Address <br />Z �L GS ( <br />Mail Address <br />��� � L �l 5 / ►� i �f <br />State icense Number <br />(�-{�lZe- S�'G� c -e-- <br />Proposed Use of Buil ing <br />City <br />��.��►Sh�� <br />City <br />������ <br />City <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />State/Zip <br />State/Zip <br />,� <br />State/Zip <br />Phone <br />Phone <br />� S-z ��z�=3y6- 5 z 7 <br />Phone <br />�����. �_- <br />Contract Price of Work <br />Contact Person (Plan Review) <br />Description of Work to Be Done: � � � j� ��1. �� }��.� � � � � y �' `- � � `� ��-� '(`� r1�4`���'�— <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certify that I have read and examined this applicatron and know the same fo 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 grantrng of a permit does not presume to give authority to <br />violate or cancel the provisions of any other state or local law regulating consiruction or the <br />performance of construction. That 1 am authorized by the owner of this property to perform the <br />work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br />296.200 WAC. <br />�- <br />� <br />� <br />:, , 1�' �,�� ,�_7i=y"; � <br />-`-� Siqnature ' � � Date <br />REVISED 3/20/13 <br />FEE <br />( ��� � <br />PERMIT# <br />E����.- ��`i <br />