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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERFTT PERMIT SERVICES <br />3200 C[DAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — v�nv�v.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />�{2v s �`� -A�e �r�l <br />PROJECT ADDRESS <br />�o�nsrn�.-�-tomas � i�c'q�o�i� 3zo°I <br />Ouner <br />Tenant <br />Eleclric;vl Conlroclor <br />Idail Addmss <br />��Q ,S1Q. �oS, ��f' ' <br />City Siale2�p <br />Cily Slatc/Zip <br />Nc. P o. (��y. ? �7S � `-�n�4w����� <br />A1ail Address Cily <br />�`�1���� HG G.i: I I G(� e�( <br />Slale License Number <br />S�r��le.�d,U,1y V�O�JSR- <br />Proposed Usc o( uilding � <br />Description of Work lu �e Done: <br />�le�k'w a.P <br />NOTE: WIFING IN NON-DWELLINGS IS REC�UIRED TO <br />(�E IN RACEWAYS, MC OR AC CAOLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />Slalc2�p <br />'IbOO."—' <br />CoNmcl Pricc of WorY. <br />��,o�� <br />PhOn9 <br />2�• 3 3� --1 �S'I <br />Phonc <br />Contacl Persen (Plan Review) <br />1 hemby certily fhat 1 have read and examined fhis apl?�icafinn and hno�r fhe same fo be fruc and <br />cenecL All prowsions olla�rs anA ordinances governu�g this f}�pe o/ �vork irill be cornpleted <br />�rhether speci�ed hemin or noL The granting oI a pennd �oes not resume to gi��e aulhonfy fo <br />Nolafe or cancel the Provisions o/any other state orlocallarv reguPting censUucfion or Ihe <br />performance oI constraction. Thaf I am authonzed by the o�rner o! Uus propeRy fo perlomi the <br />a�ork /ontiliich application is rnade and I comply n�dh fhe S(afe Contractors Law 16.2i RCN�and <br />290200 INAC. <br />FEE <br />