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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"�2�- jl�Zt� S� � �vere'l� L1l%�- <br />PROJECT ADDRESS <br />Owner <br />Mail Address <br />��(� �•�ei� �t l- ��SS <br />Tenant Mail Address <br />City <br />City <br />State/Zip <br />State/Zip <br />Phone <br />Phone <br />�����. .������ ��z� �.� ast ��� s�;o� �..���� w;�- y�o� �� �3�����-Zo�<, <br />Electrical Contractor Mail Address City State/Zip � Phone <br />State License Number <br />�,tV{�,i���('/{��i1 � � <br />Proposed Use of Building <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />�, 5�0� <br />Contract Price of Work <br />���[, <br />_�q�Vl �[xVtN �v�C�- <br />Contact Person (Plan Review) <br />Description of Work to Be Done: ��5��� .�' Z�v ,�1 wt �,P-,vtz I� w i Wz i-jU',t�"- 11 v. i�--, � 5 <br />� � <br />� �\ ;ik�- ��.',:�r�5 � 2 e✓�-�✓��-zv�c� � -hc� fi Si��S v,���i ti �� dJ ��e-1'S �.�.. � <br />5 �r , ��� S <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 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 complefed <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 aufhorized by the owner of this property to perform the <br />work for which application is made and ! comply with fhe State Contractors Law 18.27 RCW and <br />296.200 WAC. <br />� �Z <br />REVISED 3/20/13 <br />FEE <br />22� � ° <br />PERMIT# <br />Ei�l z� �7� <br />