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ELECTRI�AL PERMIT AP�LICATION <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 /> APNLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> �so i m�1v�n A��. � <br /> PROJECT ADDRESS � <br /> �Sk�e. Dwc\W s <br /> Owner I✓ailAOdress Gty State2lp Phone <br /> Tenanl Idail Address City SWte/Zlp Phone <br /> fl�-;s�� N�,�, t�.i� �n� I��ay �1�.s�- S�E ���, � �8a90 `1aS 33SIa�5 <br /> Eledrical Contrador Mail Address � Cily SWIe2ip Phone <br /> �-id-c <br /> a�;s�949Na la k <br /> Slalo License Number Contracl Price oi Work <br /> �2R,.s�al - <br /> ?roposed llse oi Building Conlact Person (Plan Review) <br /> 'JoscriplionofWorkto�oDone: ��RC�'�ILq�. � L��J ���+q� 47ii.'-fj �rl l'3fW du��Q�C ��4�1C1 <br /> � �T— <br /> NOT'[: WIRIIJG IN IJON•DW[!LINGS IS REQUIRED TO FEE <br /> DE IN HACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hercby certi.'y fhaf 1 hare read and examined this applica(ion and know the same to be(rue and <br /> correcL A!I provisions o/laws ond ordinances govemmq fhls fype of work will be comp/eted <br /> whefher speci6ed herein or not. The pr�nting ol a permif does not presumo to give aufhonty fo <br /> violateorr,ancelfhe provisionselanyolnerstateorlocallawregulafingconsWcl�onorlhe <br /> perfomiance o/consfn�ction. Th:.t 1 am aulhorized by fhe owner o/fhis property to peAortn fhe � � <br /> work lor which application is maUe and 1 comply wifb;;ie State Contractors Lew 18.27 RCW and � <br /> 29G200 IM1�AC. ��` 7- I <br /> )0 <br /> �� $ 9 ai' <br /> Signaturr. Da�e <br />