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• -- - - -- ------ - --- -• <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.everettwa.org <br />t-f G is j t: �j��� /��IQ,i'I� G�Jct�y-• �/D/ <br />PROJECTADDRESS <br />/I ! /`."�:" _/I n• .• //n/ <c� L� �aii OD /.�/��A rio�a�. i!•e� 1��_ o: <br />JI - r � —y of .u•yu=u !n au W • — — •—� <br />Owner Mail Address City Slate/Zip Phone <br />Tenant Mail Address City State/Zip Phone <br />29zoY <br />67y&VV Gdar. yzs 3-3 <br />Eledirical Contractor U Mail Address City State/Zip Phone <br />96z/�61 rlDn <br />Stale License Number Contract Price of Work <br />u 'Cl'— <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) <br />Description of Work to Be Done: <br />FEE <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 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 goveming 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 orlocal law regulating construction or the / <br />performance of construction. That 1 am authorized by the ownerof this property to perform the t <br />work fcr which application is made and 1 comply with the State Contractors Law 18.27 RCW and 1 V (l <br />296.200 WAC. <br />/ I I {�iy�� <br />�ignature a Dale <br />REVISED iaai, <br />