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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 /> /3© , /tr)s 5-172 S, - e-v- --e_41— U./tie 910-Q<< <br /> PROJECT ADDRESS <br /> ' ,►nc„ c1iv c-1-1-2/1C-• /36 b /03 Sil 5a f r-c4l- uA(,. ?kz ocl' <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> A6cjv aCO/1--°— <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> State License Number Con ract Price of Work <br /> Proposed Use of Building Contact Person (Plan Review) <br /> 1 7 Vig <br /> Square Footage (If residential new construction, remodel or addition) <br /> Number of devices (If low voltage) <br /> Jf� 'l r 9 <br /> Description of Work to Be Done: ,S:I t.,�\ S't,1,D,7c.t)1/se ' _c;-y- aLI-)-l.-0- f t'c- \-\,,, <br /> , bAy,ora.A--- rckiti- <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105n 0 <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 the E 13 7? /1 / <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> ar,,,._, 64 , ,,,- , _ / .5 <br /> Signature Date <br /> REVISED 3/20/13 <br />