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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 /> � �/� ���(s�� � �'�����% <br /> PROJECT ADDRESS <br /> Owner Mail Address � City ��,�� �G State/Zip Phone <br /> ��1Z �"��`�` �-- Y �`�> ��S <br /> �C /' ,r� _ / -�-,,� <br /> ��( _ � /aL �s��"���C�-•"U ��t'�'�'% / `l /� j SJ��%� `l'�� <br /> ✓ � <br /> Tenant Mail Address City State/Zip Phone <br /> D V�i��i/ <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> ��c � c� � <br /> State License Number Contract Price of Work <br /> Proposed Use of Building Contact Person (Plan Review) <br /> Square Footage (If residential new construction, remodei or addition) <br /> Number of devices (If low voltage) <br /> Description of Work to Be Done: �9i//���-�-- / �L����� � ��� /� �c���� <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 ��(.��'� <br /> 1 hereby certify thaf I have read and examined this application and know the same to be true and v <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 presurr�e to give authority to PERMIT# <br /> violate or cancel the provisions of any other state or/ocal law regulating construction or tl�e <br /> performance of construction. That I am authorized by the owner of this property to perform the E �� � � � '? — �/� , <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> =��-,�; ��--� �-���� /� <br /> ��� -� <br /> Signature Date <br /> REVISED 3/20/13 <br />