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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVECES <br />3200 CEOAR S7REET, EVERE7T, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />ApPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM • DEBIT 8 CRE01T CARDS ARE NOT ACCEPT�D <br />07513 /-C.-r�'tcz�c� 1�, <br />PROJECTADDRESS <br />Ownor <br />Tenanl <br />' 61ai1 Addrees <br />Mail Addreae <br />�1P. CIn.lC., l 3� <br />Electncal Contmclor <br />Addre6c <br />/-�vcZ-sq��rc� <br />State LIt2�50 Number <br />� / /._ a fu � [ L��Mt.�� <br />Proposad Use o 'Bwltling 1 <br />DeScripUon ol Work to Be Done�. <br />Slale2ip Pha <br />�S—�O�— <br />JlatuuM <br />iTone <br />/�� �4��d�• F��L� �(J/�'���� ��JZ/7� <br />NOTE: BERN RAC WAYSWMCLOR CI CABLEUIRED TO <br />���Y Slele�21p Phone <br />� 90�� <br />Conlnct Pnce of Work <br />Contact Person (Plan Re�ev.� <br />d'.�t1 /C� C'e1,�C1uc_�u� <br />PEE <br />CITY OF EVERETT LOCAL 5A1E5 TAX CODE IS 3705 <br />I hereby certiry fhat I Aave read end ezamined this app��carion and know fhe same fo be frue and <br />comect Ai�provisions o/la�vs and ordinances 0a✓e�mng this rype o/work will �e corttp�e�etl <br />w�el�er specd�etl Oeiein orooL The gnnfm9 0! a permd does nolP resume to givic e�fhon ,N to <br />violete or cancqI the provrsions ol any other stato o� �ocal (aw �egulafinq consfruction or fhe <br />peAormance oI COnsfNGfia?. Tnat ! am autAorized by tha owner o( this pfopeAy fo peAorm the <br />work !or c�hich eppl�cation �s rnade and 1 cromPty wd� rpe Stafo Contracras Law 18.27 RCW and <br />298100 WAC. <br />�l�e �u��h�� —�13��� — <br />Signelure A�� <br />�VJv � ��O <br />Z0 39t1d <br />�I21103�3 a3QNVl <br />998��95S�r BO:ci 500L/ZE/SO <br />