Laserfiche WebLink
ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETf, WA 98201 /i% "a S--0 s <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org EO S�D —l� z- <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />3� ? Z R`v� K � /�J� <br />PROJECT A�DRESS <br />C'� <br />Owner <br />Tenant <br />—Co • P <br />61aJ Atldress <br />Mail ACtlress <br />,'�� T. <br />6lectrical Contractor M11ail Address <br />S� O�O w�GS l I O P�-.! <br />Slate License Number <br />��( ✓ c.. z'1 1_. Jece� <br />C�ry <br />� Ciry <br />Po 3o�c 27� S <br />ciry <br />FrP r.��T �e,,.Tc <br />Pwposed Usc of BuJding � <br />Description of Work to Be Oone: („J� ��` �'{ � L� <br />NOTE: �VIRING IN NON•DW ELLINGS IS RE�UIRED TO <br />BE IN RACE�:VAYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br />StatePip <br />State2ip <br />State/Zip <br />�t25 -33q <br />SSOZ <br />Phcr.e <br />Phcne <br /><I L s-33! <br />98Z51 <br />PhGne <br />I c� Z S % , "_— <br />Contr ct Pnce ef 1Nork <br />Contact Pcrson (Plan Review) <br />I hereby certily lhat I have �ead and examined fhis applicafien and know fhe same !o be frue and <br />correcL All provisions cf la�vs and ordinances )uveming thrs type or wcrk wdl Ge complefad <br />whethe�specilied herein urnot. ihe granfing o7a permd dces net presume (a give authonty to <br />vrolate or cancel fhe prov�sions o(any e(her state erfocal !aw regu/ating construcfion or fhe <br />peRcrmance ol censtructien. That I am authonzed by the awner ol 'his property to perform the <br />wwk ror �vhich applic�Gen �s made and I com,ply �ti•itb the Slate Cuntrac;ors La�r 78.27 RCW and <br />296.200 41�AC,_� + <br />, � � �� <br />-,,�.- I , <br />"��l / � \—•;1% I `( � �J � <br />J�gnature � Ua�e - <br />FEE <br />��3,�� <br />� <br />/ �"� I�� <br />� <br />