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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 /> gf'/ - 3 5-/--: virP qua/ <br /> PROJECT ADDRESS <br /> < ¶&rud //-33 <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> Electrical Contractor Mail Address C't State/Zip / Phone <br /> RoRi/-751)D04 C G <br /> State License Number Contract Price of Work <br /> Proposed Use of Building Contact Person (Plan Review) <br /> ,6707 z . <br /> Square Footage (If residekftial new construction, remodel or addition) <br /> Number of devices (If low voltage) <br /> Description of Work to Be Done: l <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 7 r°2 <br /> I 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 PERMIT# <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 theE <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> . '/ori / .il h��/ c77!/ <br /> 0 igna ure Date <br /> REVISED 3/20/13 <br />