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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 />I-� � 1' ! 1 � � <br />PROJECT ADDRES5 <br />_�, � : �� _1�;_, � <br />Owner <br />Tenant <br />A,^PLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />� <br />�l�l � 1 � �1 � � . ,� � <br />Mail Adaress <br />Mail AddreSs <br />C�ry <br />City <br />n_, ., -- <br />� <br />1 _ l� ` ` � <br />\�"�/+�.1` �\w�����1� 0 ��\i'X l- <br />Electncal Contractor <br />Mail Address ���Y <br />� 1��; �I �`� l� "� -��Z�/ Z <br />1� — <br />State License Number <br />.�'�� � �� � n � <br />Proposed Use o( B�ddmg� <br />' � .` � J . <br />Description of Work to Be Dane�. <br />NOTE' EIRN RACEWAYS MC OR AC CAB �UIRED TO <br />CiTY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 heieby certily lhaf 1 have read anAea�arnincAfhis applic <br />conecf. All piovisions of laws and ordnronces govenung <br />v nl�to o� cancrf f �� rpe��o��r�os o� ��� 9olher�9late or loc3 <br />perldmance ol constructian.� Tn if i am authonzed by fh� <br />vork �or whic appbca(ion is�n• Je and I�nply� wdh the <br />zss zoo wq� � � <br />� 1�, i' � l � ��� <br />I��� �� �� G <br />36on and know tne s� <br />flus lype o/ work wdl l <br />.�..« nnt nrnsume la <br />;- !6 <br />��z.l� i�c ����` ������ <br />SlatelZip Phone <br />SlalelZip Phone <br />� � ��[ ��i,`'� � <br />Slate�7� p _ � ` Phone � <br />l, V 1 �L.' — L`1 <br />hi-��� ,.. <br />Contract Pnce of Work <br />Contacl Person (Plan Review) <br />�c (o Le f�ue and <br />� compleled <br />�ve aufhonty to <br />'fion or fhe <br />to perlomi fhe <br />18.27 RCW and <br />FEE <br />��I i�`�-L��(o <br />