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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 /> �� D3 �A1 � o�� <br /> PROJECTADDRESS 4z�' �t1 <br /> �I� .�v�b��- I ?�a� �q���(�� .��.�<;14�a, �,9�rlS a3�-�laa �l <br /> Ownar Maii Address City Slate/Z�p Phone <br /> Tenanl MailAddresf Clly State2�p Phane <br /> owne,+� <br /> E�ectrical Coniractor Ma�l Address City SlatelLp Phone <br /> State License Number Contract Price ol Work <br /> Proposed Use of Building Conlecl Person (Plan Review) <br /> Square Foolage(If residential new conslruction, remodel or addition) <br /> Number of devices(11 low voltage) <br /> Oescription of Work to Be DonIe: �.F' .l�l ��'C.J" �'� / ����� <br /> _ � Vt. I `Q.1—KJ <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 G,D� <br /> 1 hemby ceAily(hat 1 have read and examined fhis epplication end know thc samc ro be frue and <br /> corroct. All provisions ollaws end ordinances goveming fhis type ol work will bo complefed <br /> wl;efher spodlied herain or not. The r�mnting of a pertnit does nof presume fo give eufhonfy to PERMR# <br /> violufe or cencel fhe provisions ol any olher sfate or/ocal law regulating conslruction or fho � I � ' I _ O��`/ <br /> peAomiance ol consfrucfion. Thnt I am aufhonred by the owner ol this property fo peAorm fho b <br /> work/or which npplicafion is made I comply with the State Cont�cfors Law 18.27 RCW ond <br /> 296.200 W . � <br /> i <br /> .� <br /> Signat e Da e <br /> ae viseo v1ar� <br />