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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 /> --7� <br /> + �- <br /> PROJECT ADDRESS <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> !�(ZA-5-5 `7 P( 11L?f <br /> State License Number Contract Price of Work <br /> � l� Contact Person Plan Review <br /> Proposed Use of Building ( ) <br /> Square Footage (If residential new construction, remodel or addition) <br /> Number of devices (If low voltage) <br /> Description of Work to Be Done: 1,,,�W N G�1 :T7iCa <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 , <br /> I hereby certify that l 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 l am authorized by the owner of this property to perform the E <br /> work for which appli tion is made and l comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> Signa ure Date <br /> REVISED 3/20/13 <br />