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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 –Nnvw.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT AGCEPTED <br /> ' l-�Ci�� f-�o U�-. <br /> PROJECT ADDRESS <br /> �1��� ��; . �� t��c5 N��fi F_���;�. ti-, �,_ u-� 5 ,s�� 3��34 <br /> OWner P.tail Fadress Ciry Stata-Zip Pnone <br /> Tenanl Mail Address City Slate2ip Phone <br /> C,1 < 1 ��c�YL i C .L - ��Sj 1�c�6- �+ C A'�.^- C''l,�s'{L�� 1.u4��fl i:5 �2� ��; ��_ <br /> Eleclrical Contraclo� Mail hddress City Stale2ip Phone <br /> �('e11�1 �Th � C 1�{ �GCti: CO _ <br /> Slale License Number Conlract Price of Work <br /> � • C. L� - <br /> Proposed Use ot Buildin9 Contact Person (Plan Review) <br /> Descriplion of Work lo Be Done: �v--S�' �� �''u' A I'�a"t' '��-� (�� n � e,� c�-u `, <br /> :-� �,ti-`,�r� 1 ' - �� �� <br /> — ��' <br /> NOTE: �VIRING IN NON-01VE�LWGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, t.4C OR AC CABLE. <br /> CITY OF EVERE7T LOCAL SALES TAX CODF IS 3105 � <br /> i i hereby certi(y fhat I have read and exmnined fhis npplir.alion and laio�v the s.�nie (o bc tnia and <br /> correct All provisions of laws and or'dfnances povenung this type ol noik n�ill be. cornpleted <br /> whether specfied herein or noL The�ranting ola penrut does not resurne to 9ice aidhority to <br /> violate or cancel Ihe provisions eI any ofher sfate or local law reguPfing construction or the <br /> peAormance olconsfruction. That I am authorized by the owner ol;his property to perform fhe <br /> wo�k lor which application is rnade and I compl}�wilh Ilae Sta(e Confrxlors Law 1 tl27 RCIN and <br /> 296.200 WAC. <br /> i �y � <br /> �t,.�.� � � <br /> T�.:w`.:c. <br /> �� Signature Date <br /> i <br /> �j C' � / JS <br /> '--- —— - — -- <br />