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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 />�5v�^ �% k�' /��- �C <br />PROJECT ADDRESS <br />��i��, l�Cii��vv�lG;�'I- Vl/Lw�;�� - L.v�n-�� �L�°�� ��-tz' �� S� <br />Owner <br />Mail Address <br />City <br />L ��� � iw!"�- `( � L`�'� <br />State/Zip Phone <br />I/��j`��� C(JVV� WW 1'1 �G� ��ti v.T-L� �� � t�� � �� / A� S � � V�,/'ZJ�� �..J l�T � 0 � � <br />Tenant Mail Address City State/Zip Phone <br />I�v���v^�z� ��-r�2�e,rc��r�a:-� � �� ��� �,�;-���, 5�. ��+�� �J� � `� ���� <br />Electrical Contractor Mail Address City State/Zip Phone <br />► �E�2��L���ZSi3 =1� j�0_vv <br />State License Number Contract Price of Work <br />f� � � �,.%r.�u;.rC\ - <br />Proposed Use of Building Contact Person (Plan Review) <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />T ws�,��r.�f-i �� � �+�,%D ( 2 � --t���;�-�c,;,-{-z„�f-� <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 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 permit does not presume to give authority to <br />violate or cancel the provisions of any other state or local law regulating construction 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 />�ti� <br />Signature <br />REVISED 3/20/13 <br />FEE ��,rt1C.� <br />� lJ <br />PERMIT# <br />� <br />El> IC� - O`�U <br />