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ELECTRICAL PERMIT �PPLICATION <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 8 AM TO 4 PM <br /> � • <br /> �ijj � , ti �.i .��,� � �,�- y � i� 1 ;/� ', % ��iU �� �� '.(�.;�-f �`:.U , <br /> PROJECT A��RESS <br /> , ,.. � <br /> ��nr,, ,, , / , ,,, ,-� — <br /> Owner <br /> �dail Address City Slate/Zip Phore <br /> �� _ <br /> � � '- �U � �'`"'���I'� I� �� - � :'�'-''.�.ld �.�4. ��;::.�-� L� IG yo�� <br /> 1�'�t �:Vl�,.ti��'k� �� �����; , � ' t� � <br /> Tenant <br /> Mail Address Ciry StatelZip Phone <br /> � �� , t�, ��{�( -4l6�'1'I�.IJ'�'� <br /> ��,��r i'�,, � � - ' ,' ; ���v) i :, i �,.� � �'.��• � ; � , �,..u„� �_ 1 <br /> Electfi al Contractof Mail Address <br /> ' Ciry Stale/Zip Phone <br /> � i N i E!' rIJ ���;�.i-T� ��,��� r �1 <br /> Contract Price of Work <br /> State License Number <br /> i J ,1 '„I,� f, 1� �� <br /> )���ii'S�i'" ' � � �' �'Zi( � ��"l�� � "" ' Contact Person (Plan Review) <br /> Proposed�se of Building , <br /> r <br /> . r , ,i� ' n u i,t ' l�:t E'I r: � l <br /> Description of Work to Be Done. ��' �C 1 � � � � �" � <br /> ti <br /> �'d 1 n, <br /> (r <br /> -` <br /> , NOTE: EIRN RAC WAYS MC OR AC CAB 4UIRED TO <br /> FEE <br /> 5� (��� <br /> ✓ <br /> i � CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> ��II hereby corfi�`y thaf I have read and examined this applir.ation and know fhe same to be trur.and <br /> conecL All provisions o/la�vs and ordinances governmg fhis type of work will be compleled <br /> rihefher specilied herein or noL Tho granBng o!a pennd does not presume fo give aufhonty to �: i `_( � - I � `. <br /> vmlafe or cancel fhe p�ovisions ol any olher sfate or local law regulating consfruction or the <br /> per/omtance ol constnictan. That 1 am authonzed by the owner o/this property to perform the <br /> �vork Ior which applica6on is maav and 1 comply with the Sfate Confractors Law 18.27 RCW and <br /> �96 200 WAC. j,.' <br /> {i �� ' � <br /> � <br /> � �' //-12 - �� <br /> �,_ Wre�� . Date <br /> ��i <br /> - --- <br /> ----- — — <br />