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�LECTRICAL PERIVIIT APPLICATION <br />CITI( OF E�6ERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-Sfi10 - FAX 425-257-8857 — �nnvw.everettwa.org <br />APPLICATIONS ARE ACCEP �ED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />5�a� L.(7l�)r�7� �F7 <br />PROJECT ADDRESS <br />!�I�L u72�j9�J �,�L( <br />nW���� Mail Address <br />Tenant <br />Mail Address <br />Contractor Mail Address <br />City <br />City <br />��c �� �G(S <br />�1 � 7�1,�7 '?�J (n � L � <br />State License Number — <br />�.SS-t!/.�C�i,7�t41 — �i I� <br />Proposed Use of Building <br />Description of Woric to Be !?one: <br />NOTE: WIP.ING IN NON-DWELLINGS IS REQUIRED TO <br />BE IN Rr�CEWAYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CQD� IS 3105 <br />Clty <br />Stato2ip <br />Slale/Zip <br />State2ip <br />Phone <br />Pho e <br />3�0 �s- ���z <br />Nas ��[7 <br />� 6�, � <br />Contract Price of Work <br />Cont,ctPerson (Plan Review) <br />/ <br />I hereby certily that I have read and examined this epplication and know the same fo be tnie and <br />correr.t. All provisions o/laws and ordinances goveming rhis type of worh wlfl be comp!eied <br />whFther specified herein or not The granting o/ a perm�t does not presuma fo �rve authonty fo <br />violate or cancel the provisions o/any other state or focal law regu/atingpconstruction or the <br />wo�k%rawh/ ch appl/ cation s�mede end 1 comply with 1 e 8tate Cont acicrsPLaw f8 27 RCW and <br />296.200 WAC. <br />FEE ` J' <br />E 05d8�- tlz7 <br />Phone <br />