Laserfiche WebLink
ELECTRICAL PERMIT APPLIGATION <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 />lLll � 7 J� �� �f. �J � �1/e`e� �� �c3 <br />PROJECT ADDRESS <br />Owner Mail Address City <br />�r � � � � � .St� � z �`� ��� � `�/�" 7S"T � ��` ,�� �L��' e 7I`" <br />Tenant Mail Address City <br />5�� �ic������ <br />Electrical Contractor <br />State/Zip <br />Phone <br />w.� ���3 �a�=.���- y, <br />State/Zip <br />Phone <br />�� � ���� t� 5���� ��3 ��,�� ����P �� q � y3 � 3���.y � ���1 <br />Mail Address <br />S� �� �� � �, �7� ��� <br />State License 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 />State/Zip <br />��� a�� c <br />� <br />Contract Price of Work <br />Contact Person (Plan Review) <br />Phone <br />/ � /� � �� !1 %� l�t/ ��L� f �f /' �� G /, � �l � / ` +� � � �� r, <br />Description of Work to Be Done: � � � <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 frue 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 permrt does not presume to grve authority to <br />violate or cancel the provisions of any other state or local law regulating construction or the <br />performance of construction. That I am authorized by the owner of this property io perform the <br />work for which application is made and I comply with the State Contracfors Law 18.27 RCW and <br />296.200 WAC. <br />�-��� � ,��-�� � � ' / � -- �� � 13 <br />Signature Date <br />REVISED 3/20/13 <br />FEE C� <br />5� � _� <br />� <br />PERMIT# <br />E�3�Z-O�U <br />