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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.everetlwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />�9a�% /TOCA'b/�ELLt�Y1'NfNUF �V4-K['Tr 9��0� <br />PROJECT ADDRESS <br />Owner <br />Tenant <br />Electncal Conlraclor <br />Mail Address <br />Mail Address <br />�9PO.� �N/ o Ny a � <br />State License Number <br />� � cy� vri'ic r 1 <br />Proposed Use oi Bui�ding <br />Mail Address <br />City <br />LLE.Y <br />Square Footage (It residential new construction, remodel or addition) <br />Description of Work lo Be Done. <br />SI <br />NOTE: EIRN �C WAYS MC OR AC CABLEUIRED TO <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />City <br />9 9< <br />StatelZip <br />StatelZip <br />SlatelZip <br />Phone <br />Phaie <br />y�S <br />Phaie <br />%�. � <br />Contrad Price of Work <br />v,9NC,9.c�i o.e �r /I"awa' <br />Contact Person (Plan Review) <br />c ire o�i �' <br />y certily fhat I have read and e.ramined fhis applicalion and know the same to 6e frue and <br />All prov�sions ollaws and ordinances goveming fhis fype ol work will6e complefed <br />r specdied herein or nof. The grantmg ol a permd dces not resame fo give authonty to <br />or cancel the provisions o! any olher stafe or local law reguPhng construchon or the <br />iance o/ consiruchon. That I am authonzed by fhe owner o/ this property to pedorm fhe <br />r which appbcahon is made and 1 comply wrth fhe Sfafe Contracfors Law 18.27 RCW and <br />l�r� (�-, /� �/2c�l�z <br />FEE � �1 <br />6`"" <br />�Iz D�-1�� <br />