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ELECTRICAL i'ERMIT APpLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, W 4 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www•everettwa.org <br /> APPI_ICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> /",, ' y l/./z�rti ^� e � V l' <br /> PROJECT ADDRESS J��' !.�.�"%� <br /> � � / , � � <br /> ; ( / � <br /> . �� I /��� D � IL�Oj4�L� ��� J/l,�� x�:ti. l�✓ �` <br /> ( �• � ,•l, City State2ip Plione <br /> Owner Mail Address <br /> �� ��.� (� StatelZip Phone <br /> Tenaol <br /> Mail Address Ciry <br /> // / / /,�✓[.� If�51 3[v '��J' J�y� <br /> /� ��?G/`f h /t�,f�� (� ��/1 ij, ZJ7 / J�1,�h ���/ l / 5tale2ip Phonc <br /> , � • Cily <br /> Elec�rical Contracto� Mail Adtlress <br /> �-- <br /> Conlracl Price o(Work <br /> State Licens^_Num6er <br /> Contacl Person (Plan Feview) <br /> Proposed Use c(f3uilding <br /> � ✓ �/ <br /> � ��.. ��_ .r —�'�t/f <br /> Description uf Work to C3e Donc+: <br /> ----- <br /> __ I <br /> NOTE: BERN�CEWAY�S MC OR ACICAB QUIRED TO <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> coe%cty All�p ovis ons o(lalvs e3d ordiaance�gove n�ig flu's�fype o�woik will�be conobilejed and <br /> wl;other specdied herein o�nol. Th^grantinc�o/a pernut does not resume to g�ve authority to <br /> vi�late or cancel the provisions o(any ofher sf�fe or local law�eguPUne�consfruchon or the <br /> p�-�fomiance o(construclion. That I am authorized by fhe�wner o/fhis propeity fo peiform fhe <br /> work lor which application is made and I compty wifh Ihe Sfate Confractors La�v IB.27 ftCW anA <br /> 296.200 WAC. <br /> /% <br /> r�' � L i<-� c> (; <br /> �ate <br /> i S' na ure -� <br /> a � / � / <br /> � <br /> �..�l.l L <br /> I <br />