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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 /> PROJECT ADDRESS <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> Electrical Contractor Mail Address City tate/Zip Phone <br /> State License Number , - Contract Price of Work <br /> Proposed Use of Building Contact Person (Plan Review) <br /> b d s � <br /> Square Footage (If r ential new construction, remodel or addition) <br /> Number of devices (If low voltage) <br /> Description of Work to Be Done: Q�r1 Y, 1 ✓\ G ��jL�'t'1 Q LO J <br /> v <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certify that I have read and examined this application and know the same 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 to PERMIT# <br /> violate or cancel the provisions of any other state or local law regulating construction or the <br /> performance of construction. That I am authorized by the owner of this property to perform the E C �� <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296. AC. <br /> Signature Date <br /> REVISED 3/20/13 <br />