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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 />�� � ��aa � o� <br />a -� -�- <br />PROJECT ADDRESS � �� ��� <br />1 <br />Owner <br />Mail Address <br />��� <br />City <br />W 1 / � <br />State/Zip <br />Phone <br />�u ��� ��;�� - <br />i <br />Tenant Mail Address City State/Zip Phone <br />�i�-S -3�s ��� <br />�� � � � '� �l� y l � 'r � �CJi.J�..� ( � <br />Electrical Contractor Mail Address 6ity State/Zip Phone <br />�Sc��; �c-G���� � <br />State License Number <br />�, <br />c � ; G <br />Proposed Use f Buil ing <br />JL/� � <br />Square Footage (I residential new construction, remodel or addition) <br />vl <br />Number of devices (If low voltage) <br />Description of Work to Ba Done: <br />v -- <br />� <br />� !� � ,- D �.!'�- _� �_v� <br />C`r�- L�_�i�'�i',r-C , � i <br />�� ��� �v <br />Contract Price of Work <br />���.��,GI ��'la��,., <br />Contact Person (Plan Review) <br />,� n <br />k22 l�� L c"� L2 vc?yy`1`_l ��`-i�.�� <��LE. ,. ! I �CL�/�t I G`S <br />c. ! G� # <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I 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 or not. The granting of a permif does not presume to give authoriiy to <br />violate or cancel the provisions of any other state or local law regulating construction or the <br />performance of construcfion. That I 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 />1 %/ � <br />_ >w� ✓ , �� ( <br />Signa ure <br />REVISED 3/20/13 <br />� <br />FEE <br />� �� S C� ��. <br />PERMIT# <br />E (,�;� i �'G' � - G'C` ( <br />