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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 C— 130(,-4 <br />PROJECT ADDRESS <br />-3 'fZ� 7S"�'F <br />Owner Mail Address City State/Zip Phone <br />Tenant <br />Mail Address <br />City <br />State/Zip <br />Phone <br />A�16 LL-QCiC P'­) c:) TT 5gT-)6 Y�S�-33`' <br />Electrical Contractor Mail Address City State!Zip Phone <br />State License Number <br />Proposed Use of Building <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />Contract Price of Work <br />Contact Person (Plan Review) <br />Description of Work to Be Done: r< 1 P-.4 1 Lam= pi!�rN';� (-- <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <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 goveming 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 />violate or cancel the provisions of any other state orlocal law regulating construction or the <br />performance of construction. That/ am authorized by the owner of this property to perform the <br />work for which app/h tion is mode and I comply with the State Contractors Law 16.27 RCW and <br />296.200 WAC. / 1 / <br />FEE <br />7500 <br />PERMIT# <br />E 130 S3 <br />REVISED 1120117 <br />