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ELECTRICAL PERMIT 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 8 AM TO 4 PM <br /> l�0/ /��°.c;l;// r ��/, ��/�/ � '� <br /> PROJECT ADDRESS �� <br /> � //� �(1�J_[ n1 L 7 � <br /> � / l�/L��G l n���'� Slate/Zip Phone <br /> Ownef Mail Address C�ry <br /> City State/Zip Phon j <br /> Tenant Mail Address ��'�j[j'�O '3(o S <br /> � • � � � ,��J/� , ,/ /< i 9.� 9Qo.��_ <br /> �T�� � / f , // ( /.F'� �J�� O[� � D'( �� />Of .s��,�n,Jo- <br /> City Stale2ip Phone <br /> Electrical Contraclor Mail Address <br /> ��� <br /> ��7 �,�%�� � i0`� 1� �0 �v <br /> i � Contract Price of Work <br /> State License Number � <br /> � /i�1A�� �- <br /> � �.� �i � "��`� Conlacl Person (Pian Review) ' <br /> Proposed Use of ilding <br /> Descriplion oi Work lo Be Done: � , O �v '"�� �/X <br /> NOTE: BERNRAC WAYS MC RAC�CAB EUIREDTO <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceriify fhaf!have read and exam�ned fhis applicafion and know the same to be true and <br /> conect All provisions olla�.vs and ordinances govemmg this type of work w�ll be.complefed <br /> whelher speci�ed her�in or noL The granUng o/a pemuf does not resume to give authonty fo <br /> violafe or cancel the prov�sions of any ofher sfafe or local law reguPhng construction or the <br /> perforrnance o/wnsfrucfion. Thaf 1 am auihonzed,by the owner of Ihis properl y to peAomi fhe <br /> work for which anplicaGon is rnade and I comply wilh Uie Sfale Confractors Law 18.27 RCW and <br /> zss.2oo wac. C <br /> � c ' �-/J'-4 � ���9 ) <br /> � L l� <br /> Signature Dale r \ <br /> I I <br /> � <br />