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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 5-16-13 <br />425-257-8810 - FAX 425-257-8857 — www.everettvva.org �? <br />E13os J <br />-S <br />PROJECT ADDRESS <br />UL-nc' I7 <br />Owner Mail <br />"1 F22oCZ1_� Mail Address CityStatelzip Phone <br />Tenant Mail Address City Stale/Zip Phone <br />Electrical Contractor Mail Address CityQ/ Statelzip Phone <br />W OVCAL GI CDj7L: s"� oc <br />Stale License Number Contract Price of Work <br />Proposed Use of Building Contact Person (Plan Review) <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (if low voltage) 1 / <br />Description of Work to Be Done: —nCJf) C-Z rzwt 7 F-1 fir)In7 I �— <br />FEE <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 t �0 <br />I hereby certiry that I have read and examined this application and know the some 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 10 PERMIT# <br />violate or cancel the provisions of any other state or local law regulating construction or the f j�CIC5 _ 3 <br />perfonnanco of construction. That I am authorized by the owner of this property to perform the <br />work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br />296.200 WAC. <br />z Doae'� s 11('/i 3 <br />Signature Date <br />REVISED NMII <br />