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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 /> P,'�)Q--T Or- C ALQf- TT 1-2 afLA F`151A AN ( TT <br /> Owner r� Mail Address City �a State/Zip Phone <br /> T oAx-�A� n � c ' 0 A*4 L `l'rT7 FALLS 1 � -T :LTt1-� I-7 <br /> Tenant Mail Address City State/Zip t- Phone <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> 1 PIAJ <br /> State License Number Contract Price of Work <br /> Proposed Use of Building Contact Person (Plan Review) <br /> rr-1 L-1 C-4zaf <br /> Square Footage(If residential new construction, remodel or addition) -t4 I <br /> Number of devices (If low voltage) <br /> Description of Work to Be Done: J <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 —7 J /.J 0 <br /> /hereby certify that/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 construct' That I am authorized by the owner of this property to perform the <br /> work for which applicat' n i made and l comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> Signature Date I <br /> REVISED 3/20/13 <br />