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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 B AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE N07 ACCEPTEC <br />��Iq �f0ull� �}V��� <br />PROJECT ADDRESS <br />ob�rfq <br />Tenanl <br />L�nalev E <br />Eleclrical Cor.traclor <br />II�C����IVvA�/ 51!% U'Olf/l� <br />Mail Addrs s ���Y <br />Mail Address <br />vi 'fl'►'vilC <br />Mail Atldress <br />LIIN���E�'qql�C <br />State License Number <br />v��►�e f�M��� <br />Propose Use of Building <br />Description af Work lo Be Done: <br />Cily <br />LL C. I �i��� <br />City <br />'�n�l f�� <br />NOTE: BERN RAC W YS MCLOR AC CAB nE. �RED TO <br />�Vc�r�� wQ. Y82o� <br />SIatGZip Phone <br />y��s-2qa-9�'� <br />SlalelZip Phane <br />NE J 6 t� <br />vue, wA <br />SlalelZip Phone <br />,�§- 56/1-177� <br />� 2500. ao <br />ontract Price ot Work <br />riV n � �1n <br />ontacl son ( lan Review) <br />(t'MC�nf <br />FEE <br />�5�.00 <br />CITY OF EVERETT LOCAL SALES TA% CODE IS 3105 <br />1 hereby ceitify fhaf I liave read and examined fhis apqlication and know the same fo be true and <br />correcf. All provisions o� laws and ordinances govenung Ihis type o/ woik will be completed <br />whelher specified herein or noL The granling of a permd does nof resumo fo givo aulhonry to <br />violate or cancol the provisions o/ any other s(afe or local law reguPting consVuction or fhe <br />perlormance o/consfrucfion. That 1 arn aufhonzed by fhe owner of this property to perlorm the <br />work for which applicafion is mado and I compty wdh Ihe Slafo Contracfors Law 18.27 RCW and <br />296.200 WAC. <br />IsR.,�,�,Nl �l.�f�Yf'► DV�-� �r 7" l� 0 5 - <br />�c�n�-oz8- <br />r5 <br />