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ELECTRICAL PERMIT APPLICATION- <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDARTREET, EVERETT, WA 98201 <br /> 425.257-8810 F 425-257-8857 -www.everetlwa.org <br /> (6 i4o <br /> PROJECTADDRESS _ <br /> Owner Mail Address City r Stitelzi Phone <br /> Tenant Med Ad res. Phone <br /> Electrical C or ddress City State/Zip Phone <br /> .r' <br /> Slate License Number Contract Price of Work <br /> Proposed U of Building Contact Person (Pla Review) <br /> Square Footage(If residential new construction, remodel or addition) <br /> , <br /> Number of devices(Mow voltage) <br /> Description of Work to Be Done: J '�Pgf U 1 <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 or 1()j <br /> I hemby certify that I have read and examined this application and know the s e to be a and V <br /> correct. All provisions of laws and ordinances governing this type of work will b fed -- <br /> whether specified herein or not. The granting of a permit does not presume to give authority to PERMIT# <br /> viola or cancel the provisions of any other state or local law ragulahrg construction or the I 0 r <br /> ped ante o/construction. That I am authorized by the owner of this pmpelty to Perform the ''Jl <br /> work lo•which appircation is made and I comply with the State Contractors Lew 18.27 RCW and <br /> ACt;ib . <br /> �V <br /> na ure ate <br /> REViS.:e YXLq <br />