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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 />rr; Pme tr6�3 <br />PROJECT ADDRESS <br />Owner Mail Address City Stale/Zip Phone <br />Te ant Mail Address City Slate/Zip PhoneA)(�sy <br />Y1a�g <br />}�eWg FLe�ctnL� ad y111 NE &jw9L*is.r+d , ty lt370 I-Sa <br />Electncal Contractor Mail Address City State/Zip Phone <br />State License Number Contract Price of Work <br />Proposed Use of Building Contact Person (Plan Review) <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />Descnptidn of Work to Be Done 7 . L , <br />FEE <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 d / r I L5 <br />I hereby certiry that I have read and examined this application and know the same to be true and t '/ ` <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 authonly to PERMIT# <br />violate or cancel the provisions of any other state or local law regulating construction or the r <br />performance of construction. That/ am authorized by the owner of this property to perform the E 31 I — 0-2-4 <br />work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br />296.200 WAC <br />Signature Datt <br />RFVISEDI a13 <br />