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3�12 � <br />PROJFCT ADDRESS <br />J � �'1 <br />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 />��Tw�o�'F fJv�= �.. <br />��� ���lrS <br />Owner fdail Address <br />Tenanf A1ail Addmss <br />�- �- P' G�c� 5 o nl � LEGT(ZC G <br />Geclrir.al CoNraclor �aaii Address <br />�Ci�f.�loovgL <br />Stale License Number <br />C d,�,v� <br />Proposed Use of �uildin� <br />Descriplion o( Work to 6e Done: � r�� ����� � <br />NOT[: WIRIIJG IN NON-DW[LLINGS IS REQUIREO TO <br />BE IN RACEWAYS, A4C OR AC CAE3LE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />C�n/�Ia - <br />Stale2ip <br />Stale/Zip <br />6-�4�7 <br />C-r' 070 6—O ��' <br />Slate2ip <br />cTs <br />S v �` 0 <br />Conlracl Pricc of Work <br />Con�acl Person (Plan Review) <br />0 Q �9 �•-� <br />I hereby ceriily fha(1 have read and exarnined this applicalion and hnow fhe same fo bo frue end <br />coimd. All provisions of la�vs and ordinances goveming fhis f}�po of work u�ill be comploted <br />�rhefher speal�ed herein or noL Tl�e granfing of a permrt does not �resume to gire aufhonf�� fo <br />��iolate or cancel the I�rorisions ot any ofher stafe or local In�v regulating consfruction or the <br />performance o/construcficn. Thaf 1 mn nufhorized by the o�sner o/ fhis property fo pedom� tho <br />�rork lor which applicalion is made and 1 comply �rifh fhe Sfate Cenfractors Law 18.27 RCl1' and <br />29G.2U0 lM1'AC. <br />;/�;,,�-� l' - I�`� }_ �- l q- � 7 <br />� <br />r-eE <br />E v�o(� c� `I <br />PhGne <br />Phone <br />Phone <br />