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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 />-� � -Z� �� � � s� v� � �y� i� 1 % ��� � �2 � <br />PROJECT ADDRESS <br />���E /�ii� +}���� 3� <br />Owner �— <br />Tenant <br />C� Cti��' � � <br />Electrical Contractor <br />State License Number <br />S 1-` t� <br />Proposed Use of Building <br />� �/1 � i S� �:�j <br />Mail Address <br />Mail Address <br />Mail Address <br />�l%� K-� 7 � <br />City <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />City <br />C ity <br />, <br />� q i �J� � . � <br />V l/� %� i( t:— Lti <br />State/Zip <br />State/Zip <br />State/Zip <br />Contract Price of Work <br />Contact Person (Plan Review) <br />-l-/-a,..� <br />S_3�' ��%C <br />Phone <br />Phone <br />Phone <br />Description of Work to Be Done: �� w C�� ���l V�T �j � '� � V� ��� � �-� �'"L��V 'J �v f <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 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 he�ein 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 construcfion 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 />I�'�i �'�'� � �� �_ 1�' I� <br />Signature Date <br />REVISED 3/20/13 <br />FEE <br />_�� CX� <br />PERMIT# <br />E i3��- I�� <br />