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E�.ECTRICAL PERMIT APPLICATION <br />CIl'Y dF EVERETT PERMIT SERVICES <br />32Q0 CEDAR STP.EET, 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 />� r� /�_ I CG c,t'� �"F G � F,� <br />PROJECT ADDRESS <br />Owner <br />Tenanl <br />(�'�jf"h I;r�l�l� <br />Eleclrical Conlractor <br />Mail Addross <br />Mail Address <br />Mail Address <br />� 7rr��� � � � - � �" � <br />Slale License �umber <br />'J� <br />/Cr S' 1�(��`� <br />Proposed Uso of Buildin� <br />Stale/Zip <br />Slale/Zip <br />Slale/Zip <br />a —� � -+3 <br />� �3�2�..r��� <br />`/� s si3 -� v <br />9 � zo3 <br />Phono <br />����D' e <br />� <br />Conlracl Price of Work <br />Co��lacl Person (Plan Review) <br />Phone <br />Phon^_ <br />�" —' �'-�r��� �' 15'1-�/ <br />Description of Work lo Do Dcne: _ � � � � <_�� � ��"'�-- ��"' �' ' ` � <br />lc: w� i7 r .C�Trr�fa� d �7-c� �� ¢- �'?f�r��i� /�o Ol� — — <br />NOTE: W ikING IN NON-DW ELLINGS IS REQUIRED TO <br />BE IN RACEVVAYS, ti1C OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certily fhat 1 have read and exarnined this ap�licatinn nnd know the seme fo be frue and <br />con�cL All provisions o/ fau�s and ordinances go��enuny fhis fype of n�ork �vill be complefed <br />whefher specilied heroin or noL Thc r�ranfing o( a pernuf does nol nesume fo give authonly fo <br />violafe or cancel the �rovisions o! any ofher stafe or local laiv rec�ulating constnichon or the <br />performance o( cons�rucfion. Thaf I am authorized, by the o�aner o( this property to pedorrn (he <br />�rork (or which application is rnade and 1 comply �vith the Sfate Corlracfors Law 18.27 RCW and <br />296.200 WAC. _ _ <br />FEE l <br />< <� � � ./�-�-� J <br />y_ <br />� j ', �1 � -� � ; <br />