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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 /> PROJECTADDRESS <br /> 4./2S <br /> u� fU �$�PJa�r;u EUEALtt W 9��a3 <br /> Owne Mail Address Cay State/Zip Phone <br /> _ Ga M¢ <br /> Tenant Mail Address City State/Zip Phone <br /> K)VAe r9wNelr <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> State License Number Contract Price of Work <br /> S F PO rA4 <br /> Proposed Use of Building Contact Person (Plan Review) <br /> SquareFoot�a (If residential new construction, remodel or addition) <br /> Number of devices(If low voltage) ,t /� ,rr <br /> Description of Work to Be Done: T Pw1 P Pw` Pa ( C Cor A44 t-ry I Oh _ <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 1�0 . 06 <br /> 1 hereby cedmfy that 1 have mad and examined this application and know the some lobe true and <br /> correct. All provisions of laws and ordinances governing this typo of work will be completed — <br /> whether specified herein or not. The granting of a permit does not presume to give authodly to PERMIT# <br /> violate or cancel the provisions of any other stale or local law regulating construction or the r <br /> performance of construction. That I am authorized by the owner of this property to perform file t 41 <br /> work for which application is made and I comply with the Slate Contractors Law 18.27 RCW and <br /> 298.200 WAC. <br /> J�n-e 13 <br /> S na a Uate <br /> REVISEo ITWI J ' <br />