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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 />PROJECT ADDRESS <br />%\C <br />Owner Mail Address City State/Zip Phone <br />Tenant Mail Address City State/Zip Phone <br />53 - <br />lectrical Contractor ail Address City-��yState/Zip Phone <br />GAo)i5F,Lo 1&a1-1 ki3 (- &010— <br />Stale License Number Contract Price of Work <br />�111 �P�tc1� -314o��-ate <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) �\1 <br />Descnption of Work <br />to Be Done: <br />FEE. (� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 l„' , D " <br />V <br />1 hemby certify that I have read and examined this application and know the same to be free and <br />correct. All provisions of laws and ordinances governing this type of work will be completed <br />whether specified hemin 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 I O t v 0 <br />performance of consfuction. That I am authorized by the owner of this property to perform the v <br />work for which applicaft is made and I comply with the State Contractors Law 18.27 RCW and <br />296,200 WAC. <br />L� <br />n ure Dale <br />REVISED "W13 <br />