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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 />1� C�e �C <br />_ <br />1 � �C�c _ , � "�,VP i�� i���-v l./ - <br />PROJECT ADDRESS ' <br />Owner <br />�-��� <br />Tenant <br />�-� c� <br />ElectricaG <br />Mail Address <br />� 5ii� ('��,��� � <br />I <br />Mail Address <br />City <br />,. �� <br />City <br />S�.�zc>�- 5 i�l � �C � �-iv� ����� <br />� � <br />'actor Mail Address City <br />����`.� 5/ V�� V/ — r r V <br />State License Number <br />Proposed Use of Building <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />State/Zip <br />StatelZip <br />��; �--- �'� <br />Phone <br />�--� 3 <br />�� . �,�� � <br />Phone <br />+ �� b� <br />State/Zip Phone <br />� ��c <br />Contract Price of Work <br />�C � C/�,� � t'' <br />Contact PeY n (Plan Review) <br />Description of Work to Be Done: .-1—���L1 ��� �/ G� ���� �'t' �j '�''(_ <br />� ��% ._ ��rlS� �'' 4�V1., r �-r,�.,`-�`� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certrfy that 1 have read and examined this application and know the same to be true and <br />correct. All provisions of laws and ordinances goveming this fype of work will be completed <br />whether specified herein or nof. 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 regulafing construction or the <br />performance of construction. That 1 am authorized by the owner of this property to perform the <br />work for which application is made and 1 comply with the State Contractors Law 18.27 RCW and <br />296.200 WAC. <br />� <br />REVISED 3/20/13 <br />FEE <br />���, Ca �a <br />PERMIT# <br />E f `f t:'`� - ��� <br />