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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 />j,�>,G"�' ( ( _/_ t .L_, i i ,i �,::�� � <br />PROJECT ADDRESS <br />��t _ �: �, �:,1 ; . �i��` ,i7.' � I`i,�' �, �?y c.' <br />lGki�iu' Y�tur �'�,.. � i�� �4Ji �.'i-'j rv'��� 1 <br />Owner Mail Address Ciry State/Zip Phone <br />Tenant <br />Mail Address <br />City <br />State/Zip <br />Phone <br />��t � l`���tr �.:tY� �C'c: �is1 i'�� .(£}. � `� � � ' � l.v' `'� � i�t ( �j �?/ {��r_'i <br />Electrical Contr2ctor Mail Address City State/Zip Phone <br />L i:_: �,� } 1 s," j" ,�.+<i ,: �,. j�`: -�.. <br />State License Number <br />f`-�,'��i� � <br />Proposed Use of Building <br />Square Footage (If residential new construction, remodel or addition) <br />� <br />� <br />Number of devices (If low voltage) <br />Description of Work to Be Done: ,-r � � ; -.� '��� � �' ,�, , : �;t� : !� ., i� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />�C't�.. t � <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 he true and <br />correct. A!1 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 presurne 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 ! am authorized by the owner of this proper(y to perfiorm fhe <br />work for which application is made and 1 comply with the State Contractors Law 18.27 RCW and <br />296.200 WAC. <br />� > .i <br />'---i � . <<:'� y'- ,'� L <br />REVISED 3/20/13 <br />,.- r_ , - �., ,' <br />;; <br />ate <br />FEE <br />��UJ <br />PERMIT# <br />E ��}� j -��� <br />