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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 />/.� `�o G� /'.� �f�� �ti��- �� ����'� <br />PROJECT ADDRESS <br />Owner <br />���' ���1� <br />Tenant <br />���' `T clu Z c <br />Electrical Contractor <br />Mail Address <br />City <br />State/Zip <br />Phone <br />Mail Address City State/Zip Phone <br />�� , 7 <br />/ ,, <br />�f��l> -��rs 5��� ��l �i�����ti �.�� G"`sc��� y�% C%� (��r%3 � �f �;: <br />Mail Address <br />l�l� j��L� 1 S jG' �(� I` 1� <br />State License Number <br />Proposed Use of Building <br />Square Footage (If residential new construction, remodel or addition) <br />,� <br />Number of devices (If low voltage) <br />Description of Work to Be Done <br />;%Gia� C_� �i r <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />City <br />State/Zip <br />Contract Price of Work <br />Contact Person (Plan Review) <br />� e�l � % � ���� �L �� <br />1 hereby certify that I have read and examined this application and know the same fo be true and <br />correct. All provisions of laws and ordinances governing this type of work will be completed <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 l am authorized by the owner of this property to perform the <br />work for which application is made and 1 comply wifh the State Contractors Law 18.27 RCW and <br />296. 20pJWAC. <br />Signatu <br />REVISED 3/20/13 <br />Phone <br />FEE <br />`� � C �' <br />� <br />PERMIT# <br />E � �C % � — �- l `�" <br />