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,�a?�� .g 13 � 2-a <br />� <br />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 I 2 -j �� ��" S �, <br />PROJECT ADDRESS <br />�U `��V1 ������� �'S <br />Owner Mail Address <br />C ity <br />State/Zip <br />Phone <br />��NV" v l <br />Tenant Mail Address City State/Zip Phone <br />� �� <br />Electrical Cor <br />. , <br />� � ����-� < < - � � <br />_ -��2� � 5�� ��.� �f�► �'��'a; z5 � � � �^� <br />��b`i -�. <br />State License NTmber <br />�GI;v�V�-� v � i �-t � <br />Proposed Use of Buiiding <br />Mail Address <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />Description of Work to Be Done: <br />City <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />State/Zip <br />� ��.�� <br />Contract Price of Work <br />Contact Person (Plan Review) <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 goveming this type of work wil! 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 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 />296. 200 WAC. � �� '? <br />� ��/ �' ��- �? �-13- j <br />. �. i= � - _ `� <br />REVISED 3/20/13 <br />Phone <br />r <br />c�v ��� �- �l ��L <br />FEE <br />���-�� <br />PERMIT# <br />E Q�00�_�;'�� <br />