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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 />�I� IG�t� �1 �� <br />PROJECT ADDRESS <br />v� ��, <br />�� �,�� �� ��� � �;. �� tc't �� p � 5•L <br />Owner <br />Tenant <br />9 `/ �� <br />Electrical Contractor <br />State License Number <br />Mail Address <br />Mail Address <br />d <br />Mail Address <br />�-�.��: � �� y 51� c! <br />Proposed Use o Building <br />` !� �� � �l c� ��-� <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />Description of Work to Be Done: �� r� w� �� <br />�.J � � �F <br />C ity <br />City <br />City <br />� (;,.�1+'�> <br />�,; � �� �e; � o < <br />State/Zip <br />State/Zip <br />State/Zip <br />Contract Price of Work <br />Contact Person (Plan Review) <br />�, �� �; L� -r t ��P S\"E' <br />\ ��l'' � ' � � c. C C: r ri � .� �� c .� � � <br />a �n c -� < <-�,,� � � � �„�.e � �r+ r c �, -� ,c k -� �� � � � P 1 <br />�,v� \ u -��t' c� a� �, c, Q <br />Phone <br />Phone <br />Phone <br />FEE <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 herein ornot. The granting of a permit does not presume fo give authority to PERMIT# <br />violate or cancel the provisions of any other state or local law regulating construction or the r <br />performance of construction. That 1 am authorized by the owner of this property to perform the E, `/ l �� I_. �� <br />work for which application is made and f comply with the State Contractors Law 18.27 RCW and � <br />296.200 WAC. <br />�� <br />nature <br />REVISED 3/20/13 <br />%i�r <<I Z��i <br />