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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.everetlwa.org 1�—�g�0 <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM L�OIZ'���I <br /> z /,�� ti oti RJ <br /> PROJECT ADDRESS <br /> ��, Stale2lp Phone <br /> �ef Mail Addrass <br /> �—� � ���, Sla�e2ip Phone <br /> Tenanl Mail Adtlress <br /> �'l I � S�/� 3 P, !/ �s' �'Q� �✓,� 9�ty2s/ <br /> 1 r�C n Phone <br /> Mail Address � ��ry <br /> Eledrical Contractor � <br /> � � <br /> -Cq�s Z V }- 1 � �� Contract Price of Work <br /> State License Number <br /> ` �� ��r 25"3 -686-sxlo_ <br /> R7`+ 'I Contact Person (Plan Review) <br /> Proposed Use oi Building <br /> Description ot Work to Be Done: <br /> o/�C , 7 �� r � ( o �t 1 S 'tv �f� <br /> NOTE: BERN RACEWAYS MEC OR AC CAB EUIRED TO <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> coreie�ct. All prov�sions of laws end o�nances govemPng fh s type opf work will be complet d and ���Z- (�- � <br /> violateeor�nceldhe�prov1 slons o%any othe�r state or local�w re9ulat^g constr9ctl on ot�the t� . <br /> perfomrance o/cronsiruchon. Tha:I am aufhonzed.by the owner o/this property to per/orm fhe <br /> work Ior which applicahon is made and I comply wrth fhe State Contractors Law 1827 RCV✓and <br /> 296.200 WAC. <br /> / Z , z g • / D <br /> Date <br /> Sig re <br />