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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 />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />533 � (,,),o �-�ruore �v � <br />PROJECT ADDRESS <br />M1fad ACd�ess <br />Gry <br />Tenant Ma�lAdaress Cny <br />S129 �v�y�e�r �aay <br />3 ���'< ,��c # � y3 d t'�� <br />Eie icai Gontractor —T �s�ad ndaress c�ry <br />�%U�. �G77�L <br />State L .,ense Number <br />� /"' / / <br />Proposed Us o( �mld�ng <br />Square Foolage (H residenUal new conslruUion, rnmodel oi addn�on) <br />Descnphon of Wark to 6e Done <br />NOTE WIRING IN NON-DWELLINGS IS R[OUIRED TO <br />BF IN RAC[WAYS. MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />3_a-o�i j <br />C,3o�3�rU0 <br />'2� 3_ _ Cv�s�so8- <br />Sate2ip <br />Slate2p <br />Slate Do <br />Pnone <br />Phone <br />"1 q5 <br />Phor� <br />_�c-e �or �/ i P�t /� I' <br />Conlracl Pnce of Work � <br />ContaCtPerson (Plan Rewew) <br />I hereby cerirfy Ihaf 1 have read and exanuned this applica6on and know (he sarne to be lrue and <br />conetf. All pro�osrons o/ laws and ord�nances govem�ng fh:s (}�pe ol wo�k wdl bc compleled <br />whefhe� specd�ed hernm or not Thc granting ol a pernrd does not presunie fo groe aufhon(y fo <br />violafe or cancel !he pravis�ons ol any ofher sfafe or Iecal laiv mgulahng cons6vchon or the <br />performance o/ cons(�uchon Thal I am aulho�ized by the o�vner of this property fo perform Ilre <br />work /or whic.ti app6rafron is made and 1 comply wdh fhe Sl�fe Conlracfors Lar� 18 27 RCW and <br />296. 200 INAC <br />fEE <br />�5 °O <br />�I �C�3 — ��c� <br />