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t <br />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 />�3o sw rv� � w► �I �✓ ,�,cvu �,�✓�A '1�2-bj <br />PROJECT ADDRESS <br />Owner Mail Address City State/Zip Phone <br />Tenant Mail Address City A" V,I„/5 ,� State/Zip Phone <br />�f l I Piet; w(A <br />rorzc+ors Zi-� Ito f �1(0L 2-9% 54 �✓ SLR bo :�4G'L� <br />Electrical Contractor Mail Address City State/Zip Phone <br />2La Ho\- t H P e�z>-! Q& 1 b0 <br />State License Number Contract Price of Work <br />LVtr'o v"2'Zn t a1�."ram <br />Proposed Us of Building Contact Person (Plan Review) <br />G3oo <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 />FEE <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 ��D <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 govemino 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 PERMIT# <br />violate or cancel the provisions of any other state or local law regulating construction or the z -) <br />performance of construction. That I am authorized by the owner of this property to perform the E 3(� — <br />work for which application is made and I comply will) the State Contractors Law 18.27 RCW and <br />296.200 WAC. <br />Signature Date <br />REVISED W0113 <br />