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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 /> � b �(.� ��� �v.� �� tve���t �,�� i�J�`6 <br /> , <br /> PROJECT ADDRESS <br /> � �o o�; � �% �,,:� �� Ev��.�i ���- i���� <br /> Owner Mall Address Cily State/Zip Phone <br /> Tenanl A1ail�ddress City StalelZip Phone <br /> i ,w.� ,., �1.-�- �.til 5:�w��� I �l 2t`�5 I�-1�(�l S�- 1L�,�' �^�� i'�D31 <br /> [lectrical Co.ilraclor A1ail AJdress Cily StaleRip �L r�_���Ph�a j� <br /> i �a��M� ri.����� — �,�'� <br /> Slalo License Number Conlract Price o(Work <br /> Proposed Use of Building Conlacl Person (Plan Revie�v) <br /> �escripti�n of Work l0 13o Done: �Ll I �L�l� �� � leJ"'� v'r'��� <br /> I NOTE: DERN RACEVN'AYS MC OR AC CAB�UIRED TO FEE � <br /> �`�/ <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 � <br /> I hereby certilv that 1 have�cad nnd examined fhis application and know h`�e same fo be frue and �-� ?L�' — C�"� <br /> correcL All piovisions o!/a�vs and er'dinar�ces�ovemmg this fypo ef�rork u'ill bo comp/efed <br /> n�hr,ther speafied herain or neL The�ranfinc�o(a pernut does not/n�esuma fo�ive aulhonty to <br /> violafe or cnncel fho/uovisions o/3n}�other state er/ocal lmv regu nting construction or(ho <br /> paforntance o(constn�cfion. That 1 am aufhorized by(he o�rner o!this property to pedomi fho _ <br /> wo�k lor which epplicetion is roade end 1 conrpty with Ihe Stafe Conlractors Le�v l8.27 RCW and <br /> 29G.2001R'AC. n <br /> � <br /> .-- � ��---- - �1�/��� <br /> . S onature Uat <br />