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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 93201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />ly l 9'1 s> s tj <br />PROJECT ADDRESS <br />Owner Mad Address City <br />State/Zip Phone <br />Tenant Mail Address City <br />Slate/Zip Phone <br />]-)�6 IM 103r`PtL <br />k1_1 �s Wi425, <br />1 Contrac r Mail Address City <br />State/Zip Prone <br />3Go7Zz-CaS <br />State Licerse 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 />yr�� <br />Description of Work to Be Done: <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />FEE <br />lJ <br />1 hereby certify that I have read and examined this application and know the same to be hue and <br />,r <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 <br />PERMIT# <br />violate or cancel the provisions of any other slate or local law regulating construction or the <br />of construction. That 1 am authorized by the owner of this property to the <br />t 13 �� �� <br />performance perform <br />work for which application is made and I comply with the State Contractors Law 18,27 RCW and <br />296,2W WAC. <br />zS--zo13 <br />Signature Date <br />REVISED "0/13 <br />