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• <br />W] <br />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.evereltwa.org / Z -06 -13 <br />(�-13f2-03) <br />I1�' L -)s T= � 51�3 <br />PROJECT ADDRESS <br />I <br />1s7-ZS <br />`1S"`"� Srr5l.J <br />��yf 'LtbTf WA. `"Ib-Z=ClW <br />Owner <br />Mad Address <br />City <br />Slate/Zip Phone <br />Tenant <br />Mail Address <br />City <br />StatelZip Phone <br />Ls�3 - <br />_ <br />��5% <br />ZZOT' T l(.Nrll``19asi ss. <br />E ctrical Contractor <br />Mail Address <br />City <br />State/Zip Phone <br />-S t�-& <br />Slate License Number <br />Ce3r%, o .ems <br />Proposed Use of Building <br />2,soo sCA <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (II low voltage) <br />Description of Work to Be Done, <br />,� r <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3106 <br />S 100 U °-`— <br />Contract Price of Work <br />Contact Person (Plan Review) <br />1 hereby certify that I have mad and examined this application and know Ilia some to be true and <br />correct. All provisions of laws and ordinances governing this type of work will he completed <br />whether specified herein or not. The granting of a permit does not presume to give authonty to <br />violate or cancel the provisions of any other state or local law regulating constriction or the <br />perforrnanco of construction. That I am authorized by the owner of this property to Parton Ilia <br />work for which application is made and I comply with the State Contractors Law 10.27 RCW and <br />296.200 WAC <br />fFF -- ---- <br />PERMIT# <br />E I�lz-0 J�7 <br />orvisro 3?dr3 <br />