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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: ��"J l �2 ��� �i �c �,��;� �I- i <br />PROJECT ADDRESS <br />� � f� '� ��� �G'1Li'i�,lti, Y10.iF r��jhlC � �J `� ��x ���� ����'�V CC. ��Y� � �l/��'�.��� <br />Owner Mail Address City State/Zip Phone <br />Tenant <br />Electrical <br />C:'r� �; �� � F,til�1�� .3 G�i" <br />State License Number <br />�� ����i� � <br />Proposed Use of Building <br />Mail Address <br />��:. ;��c 31c; <br />Mail Address <br />Square Footage (If residential new construction, remodel or addition) <br />l <br />Number of devices (If low voltage) <br />City <br />City <br />Description of Work to Be Done: �`CC� T� 1 E'x �`)'�c �G, �}� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />State/Zip <br />State/Zip <br />Phone <br />� `1Z5-b'�1-1�,:�s <br />( L`C`�. C:(:.,' <br />Contract Price of Work <br />Contact Person (Plan Review) <br />I hereby certify that 1 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 cornpleted <br />whether specified herein or not. The granting of a pennit 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 I�m authorized hy the owner of this property to perform the <br />work for which application is made and I cornply with the State Contractors Law 18.27 RCW and <br />296.200 WAC. <br />i � �7 <br />�� � /�.�,C. �.t" �-� <br />� ��:G� C..� <br />REVISED 3/20/13 <br />���` C' % " �� <br />Phone <br />FEE <br />�;� ; - '� (��' �J <br />U <br />PERMIT# <br />E �`�� � — ��� <br />