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ELECTR(CAL PERMIT APPLICe4TION <br />CITY OF EVERETT PERMIT ��RVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - v,m�w.everettwa.org <br />APPLICAT�ONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />( �� C� `%" �-�cz�1r �l� �- <br />PROJECT ADDRESS <br />_L�.�,�h f s.� ���.,, y�� �,�� y�,��e <br />Owner h1ail Address Ciry <br />6 �as-� <br />CoSb6-�� <br />l-'✓c,-�i � �%���c�3 <br />StatelZip <br />Phone <br />1 /� ��/e'�����(L (Z�� i��"����- �ver'�%%-`��20� <br />Tenant Mail Address City Slate/Zip Phone <br />�� ci /�1,GL`ia,�f �.� / �/ti �io� 5 2 3ZG —/Z/ S�.�ex't e��w/I, 9 �2 � <br />Electrical Conlraclor Mail Address City Statc/Zip Phonc <br />yi�33o z �30 <br />5auti(�M 5 9S�/2� <br />Stalc License Numbr.r <br />�rc � <br />Proposed Use ol Buildiny <br />�Q � <br />Oontracl Price of Work <br />��r/ �l/ �/N-'r`i7 <br />� <br />Contact Person (Plan Review) <br />/ 1 / �/ <br />Descriptiono(Worklo[3eDune: _i��n �/ ��lL I%eW ��� �/������e �ftPliv+O$�S� <br />NOTE: N,'IRING IN NON-DWELLINGS I5 REQUIRED TO <br />BF IN kACEWAI'S, h1C OF: AC CA6LE. <br />CITY OF EVERETT LOCAL SALES TAX CODF IS 3105 <br />I hereby certily llmf / haee read nnd exantined Ihis application and knew Ihe sarne to be frue and <br />corn:cL All provisions o//a�rs and ordinances goveming fhis typo of �rork u�il! be complefed <br />�vhefher speaGeAherein or noL The �ranfinc� ol a perrnd does nof �resonie to �ive aufhority to <br />violafe or cancel the provisions olany ofher: tate or local law reguloting c�nsfruclion or fhe <br />perfonnance o/ cofufrucBoJi. That 1 arn authorized b}� fhe o�vner ol fl ns propert}� to pedonn the <br />tvork lor �vhicli �pplicatio�t is ntade and ; compty �sifb fhe State Confracfors Law 18.27 RCW anA <br />296.200 WAC. .� <br />� <br />'� �- � -�.�-%2a /.� 9 <br />�- <br />SignaWre � Uate <br />f-EE <br />- ��i� <br />9oc� <br />