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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 />� ,; , <br />� ���._) � � � < < ,:! f .�: � ',� � <br />PROJECT ADbRESS <br /><'�-•• �c +� -Z <br />, �'� <br />�'t ��� '�f 4-id 1akt�,�v� Y�u« ..1<, �'. C2`� (.�t.�'i C�i��?:�� k l�� �i.,i�'� �`/���.�i.� <br />Owner Mail Address City State/Zip Phone <br />Tenant <br />Mail Address <br />City <br />State/Zip <br />Phone <br />' i <br />� ��: .��"4 l 1t�C; �'L , � � l C lt i i, i ( .� j�__� l.(: - � � 1,� i iC ' r �7 � f�' �r � !-� _ ':� <br />t <br />Electrical Contr2ctor Mail Address City State/Zip Phone <br />(, f` �,l �1 �.� t- i,,,��.�,�. � (� _�_ <br />State License Number <br />�I,J._ <br />t`"� ��i� , <br />Proposed Use of Buiiding <br />Square Footage (If residential new construction, remodel or addition) <br />� <br />Number of devic:es (If low voltage) <br />Description of Work to Be Done f--r l� �c' _'; � �',j �, '`.tft;?['�; ��?+- <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />� C'C,� � C�C: <br />Contract Price of Work <br />Contact Person (Plan Review) <br />1 hereby certify !hat 1 have read and examined this application and know the same to be true ancl <br />correct. All provisions of laws and ordinances governing this type of wcrk 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 I am authorized hy the owner oi this property to perfiorm 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 />`; ,I > / �. : <br />,/ ; a. �. " , i ' ir �� L <br />Signatur¢ <br />REVISED 3/20/73 <br />;' `� <br />i' '�_ !,� �_ i, <br />Date <br />FEE <br />��1C(/� <br />PERMIT# <br />E��O� - ��� <br />