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i <br />ELECTRICAL PERMfT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM S!,id TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />� ( � � ��b-1 � — <br />PROJECT ADDRESS � <br />v: <br />Owner <br />_-- <br />Tenant <br />Mail Address <br />Mail Address <br />Ciiy <br />City <br />1�`�iv� l l� i����- 2`41�; f'IN�' <'�t I�,.i- <br />Electrical Contraclor <br />Mai� Address Ciry <br />��tilr �(_� -�i0�7 i� 5 � <br />State License Num6er <br />�i��\� — <br />Prapased Use of Building <br />Description of Work to Be Done: <br />��f� l�c,.�, i� ,: t �'� <br />NOTE: BERN �CEWAY�S MC OR AC CAB �UIRED TO <br />�: ri-- `=1��� I <br />Slate2ip Phone <br />SlatelZip Phone <br />4�;-� �Z-99e7 <br />Slale/Zip <br />. •y ���i,,,,' <br />Contract Price of Work <br />Conlact Person (Plan Review) <br />�e_�t�y- c ��•:.�� j[ c.115 <br />CITY OF EVERETT LOCAL SALES TAX CO�E IS 3105 <br />1 hereby ceRify that 1 have read and examined this application and kno�v the same to be true and <br />correcL All p�ovisrons of laws ar.d ordinances govermng this type cp('�vork �.vill be completed <br />v olat eorPancel�he prov sions of any othe�r 9tat aereocal�a v regular ng constr9cf on or (heY to <br />peiiormance of consfrucLon. Thaf I am authorized by the owner of this prepeny to peAorm the <br />work (or �vhich app6cafion is made and I cemply with the Sfa(e Contractnrs Law 18.27 RCW and <br />296.Z00 WAC. <br />2- <br />Phone <br />LOt <br />FEE <br />� � <br />