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FLECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 —w v.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />j,� �L LC�c+�t�p/� r�v" <br />PROJECT ADDRESS <br />c.�-3—i3 <br />� i3o y�a`f� <br />���c��� L�C f d Bt+� S�l � �� �7 � �,J� ���57 .��'�,-77c Bz <br />OWner MailAddress City StatelZip Phone /� <br />�/� <br />LV'z� <br />Tenant <br />Idail Address <br />i" �■ 7-Yl t w�' <br />Electrical Contractor Maii Address <br />Slate License Number <br />Proposed Use of Building <br />� <br />�f �� <br />Square Footage Qf residential new construction, remodel or adddion) <br />Description of Work lo �e Done: <br />NOTE: V.IRING IN NON-DWELLINGS IS REQUIRED TO <br />6= IN RACEV��AYS, MC OR AC CABLE . <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />City <br />City <br />SlatelZip <br />State/Zip <br />oG n(�f) nJ <br />Contract�t rice of Work <br />Contact Person (Plan Review) <br />FEE <br />i�ZSo <br />Phone <br />Phone <br />II hereby certily (haf / have read and ezamined this application and know the same (o he tn�e and �' 2 0/' /��� <br />conecL All provisions o(laws and ordinances goveming this lype ol work will be completeA � v�' - V <br />whelher speci(ed herein or noL The graniing o! a pennd docs not prysurne to give a�dhonty to i <br />violafe or cancel the provisions of any ofl�er stale orlocal law rogultiting consWcbon or fhe <br />perlomiancv o/constnicfion. TRaf I ant au(horized by the ownero! fhis p�ope�iy to perforrn the <br />wo�k for which applicafion is made and 1 comply wilh (he Slale Confroctors Law 18.27 ftCW and <br />296.200 V✓AC. <br />����1� J�-� <br />Sig atu e Date <br />