Laserfiche WebLink
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 />. �� � �- � ��n�v .�t- %=���ff" <br />PROJECT ADDRESS <br />e r� <br />Tenant <br />Electrical Contractor <br />� -r�- � <br />ail Address <br />Mail Address <br />iG Zl� <br />Mail Address <br />r �zs � �.F � �/�"t�� <br />, <br />State License Number <br />- --- �� ��� /� <br />Pr pos�d lJ-se of Building <br />��`� <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />Description of Work to Be Done: <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />� �� <br />City <br />C ity <br />�"�aka�, e <br />C ity <br />� U��� ` <br />State/Zip <br />State/Zip <br />� «. • � c <br />State/Zip <br />,�M.�z ���G <br />Phone <br />Phone <br />'li 1,�'� - yo`�Jl � <br />Phone <br />_ � <br />� <br />Contract �'rice of Work <br />Contact Person (Plan Review) <br />!� %� i�GC�✓ <br />1 hereby certify that I have read and examined fhis 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 const�uction. Tl�at I am authorized by the owner of this property io perform fhe <br />work for which application is made and 1 comply wiih the State Contractors Law 18.27 RCW and <br />296.200 WAC. <br />0 <br />ign <br />REVISED 3/20/13 <br />FEE <br />;� � c;��> <br />,, / <br />PERMIT# <br />E ���C)`��,C��� <br />