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� �. <br /> � <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8610 - FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> /S 00 /fr f7'.Qc�6�' <br /> PROJECT ADDRESS <br /> qS2aG <br /> f OQTO� CI�E�E7T 29/� BGND Ir fTr �02 CVr�d`�� u2r•2s"9.�16y <br /> Ownef t.lail Address Ciry State/Zip Phone <br /> ff11y v� <br /> TBnaM Pdad Address City S�ale2lp Phone <br /> pAL7DF. �< «r,Pi� 3s%/ / 32 ~�'f7' Iw JT �! i r�Nwioi� w9 9?a87 vZ=787•/B2L <br /> [leclncal Contractor M11ail Address Ciiy Siate2ip Phone <br /> /7i9LTDEG 0�77/�L ��Q.7�/ ?a <br /> State License Number Conlract Price of Work <br /> p /�� i.oA1J vt�Jl =[,I .�U.SI Mi EL[� . <br /> Proposed Use of Building Contact Person (Plan Review) <br /> Descnption of Work to 8e Done�. �� ��T'�' � �!"� ���-n7C�,Q7/i�B'�C��f/�r�-E�/P/�_ <br /> �,-.�,�2��D2ciri 1'r/P.�o,PT � w,�L� � Jc•r�r� 0.-7�,Q Ml.IG <br /> Et,eGT11 i G/�'L <br /> ; NOTE: BERN RACEWAYS MC OR AC CABQUIRED TO FEE �6 <br /> � �/02l -- <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> I hereby certily that 1 have read and ecanuned th�s apphcation mid kno�v fhe same fo he tnie and <br /> conecf. All prov�s�ais ollaus and ordinances governing fhis type of�vork reill be cornplefed <br /> �rhefher specAied herein or��ot The�Jranfin9 0l a pennd does not p.�esume ta give authonly lo <br /> ��iolate or cancel fhe p�ovisions ol any o(her sfale or local la�v regWatmg ccns6uction or tho <br /> peilonnance o(conshucfon That 1 am aufhor2ed by Ihe o�rner o/fhis pr�perty to pe�form Ihe <br /> work/o�n�hich applicafion is made and 1 co;npty�rRh Ihe Stale Contrac(ors Lau� 1827 RCW antl <br /> 296.200 l4�AC. <br /> �e, ��� L/'��� 7 <br /> —`� Signatwe Dale <br /> �U� f U - IGTI <br />