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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVIC�S <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8657 — vwvw.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 6 AM TO 4 PM <br />� 15 b �' C-, m,� � �� <br />PROJECT ADDRESS <br />i.-a3-�3 <br />C%3��� �� <br />¢O� <br />i�c"��1� ��DY�'�O.S �5(7'�' G�rv% I�l C✓ert-l� l.J� �L�Z03 y0� ��05 <br />Owner Mail Address City SlatelZip Phone <br />Cit Sta elZip Phone <br />Tenant Mail Address Y 4 Z� <br />��-' �`�.�� 2qu�� I�5" PLSL ��t,�.�l �,,fl 9P�'�Z 2�s5sq� <br />�}S \1� � Slate�Zip Phone <br />Eleclricai Contractor Mail Address �'tY <br />I�u��� e. �K ��3� J �:Jii .ncJ <br />Stale License Number Con�racl Pr�ce of Work <br />I-�S 1 I��II I L�C�� <br />2;oposed Use of Building <br />Square Footage Q( residen!ial new construction, remodel or addition) <br />Descriplion of Work lo Be Done: <br />Contact Person (Plan Review) <br />NOTE: BERN RAC WAYS MCIOR AC CABRUIRED TO <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereGy certily thaf 1 have read and eYamined this application and kno�v the same to be fn�e nnd <br />correc(. All prowsions ol laws :and ordinances goveming Ihis type of �+�ork will 6e cornplefed <br />whefher specilied herem ornot The granting oI a pemut does not pigswne to give authonly fo <br />violafe or cancel fhe pinv�sions ol any other stafe or lucal law reqWatuig conslrucfion or the <br />pedomim�ce o/constnichon. That 1 an� aufhorized 6y the o�vnero/fhis pmperty fo perform the <br />u„�i� �nr whicli ann6calfon is made mid I conrply wifh the Stafe Confractcrs Luv✓ 10.27 RCW and <br />__ <br />l%� z3, z� �3 <br />Date <br />�� <br />FEE <br />����� <br />��3d� - l �a- <br />