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ELECTR�CAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES �` �,�_� Z <br />3200 CEDAR STREET, EVEREFT, \NA 98201 <br />425-257-8810 - FAX425-257-8857—www•everettwa.org ���7`D65 <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />f� l I 5 � �cte.�kk /��[� (v�-� <br />PROJECT AD�RESS <br />Ovvnef <br />Tenan[ <br />Eledrical Contraclor <br />Mait Address <br />6;�� �� <br />SLL!_�dr <br />Maii Atltlress <br />��ul <br />Mail Address <br />��-��CC� a�,��Q <br />5[ale LicansV Number <br />Clty <br />E�Si 5 <br />City <br />���: \ S1-oc`� <br />Proposed Use of Building <br />�B� 5 -�k <br />Squ re Footage pf esidentiai new construction, remodel or addition) <br />�escription of Work to Be Oone: <br />N07E: BE'RN RACEWAYS MC OR ACICAB 4UIRED TO <br />CITY OF EVERE'TT LOCAL SALES TAX CODE IS 3105 <br />! here6y certi(y tha! ! have read and examined (his applic <br />correcf. All provisions ollaws and ordinances gevem+ng <br />whe�er specified herein or noL The granting of a perm�l <br />vrafafe or cancel the provisions ol any o!her state or loca <br />peAormance of consiru�lion. That 1 am authorized, by ih� <br />�vor�c lor which applicafion is made and I compty �v�th (he <br />29&2// / � l '�'. <br />v <br />S1alelZ�p <br />� �vL� <br />StatelZip <br />� Grp� 4�2`� <br />State/Zlp <br />�� pCSD <br />Contract Price of`Nork <br />�< <� 1�}w��? <br />Contad Person (Flan Review) <br />�-s <br />VPe o( w�o� �vif! be completed and <br />�. nof presume to g�ve autha�ty fo <br />-egulating cons7uction or the <br />er o! this propeKy to perform ihe <br />Contractors Law 18.27 RCW ond <br />�-�1��12 _ <br />FEE <br />Phone <br />Phone <br />io3;, 3 ��t � <br />Phoire <br />Ei2o�-��5 <br />�d 4L£9-8VE'SZb swepyei�(N e9Z�60ZLLll�f <br />