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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 />�iG��%� ��L j��Qy�l1 � ��1� <br />'. ._ p� �� � � �ii � �J�� : , \/' / G' �L l (��r� � � <br />4 <br />PROJECT ADDRESS <br />� <br />;� <br />Owner <br />���e� <br />Tenant <br />'�d✓.1 �� T <br />Electrical Contractor <br />c�l'.r�c? l��l/ ` <br />Mail Address <br />Mail Address <br />Mail Address <br />%i/ F/ I <br />State License Number <br />���� G �1� I 2 � � I��D �� <br />Proposed Use of Building <br />� ;/� ✓� S g ��/� � <br />City <br />C ity <br />C ity <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: /�C ✓2 �i� <br />/'� �'�r�' �c:,, � ; � /�, � s � G? V"�' i.�� � 1 `£� i:� � <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />�� <br />State/Zip <br />State/Zip <br />State/Zip <br />� 300 � � <br />Contract Price of Work <br />Phone <br />Phone <br />Phone <br />T , �'YIa'1 l+ � �{'1 � � �► �-- <br />Contact Person (Plan Review) <br />�:��iw; r L S-mol�e / ��: <br />1 hereby certify that I 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 completed <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 I am authorized by the owner of this property to perform the <br />work for which application is made and I comply with the State Confractors Law 18.27 RCW and <br />296.200 WAC. <br />E <br />REVISED 3/20/13 <br />re <br />� ;i Y-- p 7 -- i <br />FEE <br />..� ;� �.., ^: ;�} ".� <br />� .�,. <br />PERMIT# <br />E � �' � �- �'� ��-- <br />�'� r "v'��r . <br />/ <br />