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ELECTRICAL PERMIT APPLIC a� N <br />ClTY OF EVERETT PERMIT SERVICES � <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-6857 — www.evereV�OJD. � .i,`p 0, D�% <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM tf�i J� ��IQ <br />�ji�i' �,. <br />,` <br />� s �cJ CUerc tf /L1�1! Gv�., <br />PROJECT ADDRESS <br />%�ro � e r�G- L�-�- , 02 a 5�0 3�'�=''' P� � <br />Cily <br />P� 4� 'JGO/ <br />ow�e� <br />1,uh ��6�H <br />Tenanl J <br />I �. F�l�i�1 in 2� � <br />Electrical Coniraclor <br />(� n ti� n�� F�a i�i y� �o <br />Stale License Number <br />Proposed r se of Building <br />Descnplion of Work to Be Done. <br />Mail <br />Mail Address <br />Mail Address <br />�e.�"H2 GJ�`> �7d! a Z <br />NOTE: BERN ACEV�iavD MC OR AC CAB�r IREU TO <br />City <br />719`, <br />City <br />Stateh+np <br />Nw.vN-, c��� �i�aa7 <br />)�,� EG�F�eti lAi1� �! <br />U StateAdp <br />rn�im <br />��� <br />Phone <br />/��' /Llf�l%��,J (�� <br />Staten+ip �d'a-i'3 ��P848�/ <br />�02o2$(p.l� l7 <br />Conlracl Price of Work <br />%�'! �- Ci h� 0u- t� <br />Contact Person (Plan ResiewF <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />l hereby certify that I have read and exnmined this application and know fhe same to 6e true and <br />correct. All provisions o! la�vs and ordinances governinQ this type of walr will be. completed <br />whefherspecilied herein or noL The granting o/ a pennd does not presume to give authonty to <br />violate or cancel the p�ovisions of any ofherstate or local la�v regula6ny const�uction or the <br />pedonn's;ic� vl consVuction. That I am authonzed by the owner o/this prop��f; to pedorm the <br />work fo� which application is made and I compty �vith the Sta;e Contractors :_aw 18.27 RCW and <br />296.200 WAC. <br />�, �. „ <br />,G,� ��2�2�,� <br />(/%G�t L�--� � "`!���/�l— —� Date <br />Signature <br />�,,,� �• Tl <br />FEE <br />��i�� !� <br />� ���,q-d3 z <br />