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{ <br />ELECTRICAL PERMIT APPLICATION � <br />CITY OF EVERETT PERMIT SERVICES � <br />3200 CEDAR STREET, EVERETT, WA 98201 �,� ; <br />425-257-8810 - FAX425-257-8857—www.everettwa.org -(; <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />,�•� <br />' •:; S S � <br />'� �.� -� <br />PROJECT ADDRESS <br />— . -, ` <br />� � � `� r s �:. <br />L.Gv21 s c� �) ,� i�� �-Z � S� <br />Owne� Mail Address City <br />Tenant <br />a <br />Electrical <br />Mail Address � <br />— �,., ;��� <br />� �;c Sia•l-2z� <br />Mail Address <br />`i //-S�i ?— <br />C J r I�e �'� �-.� _�, �,, — <br />State Lfcense Number <br />.i r . ` <br />Proposed Use oi Building <br />Cily <br />l',,�� �,1 � % , J .. <br />State/Zip <br />State2ip <br />Phono <br />Phone <br />S�J /�¢,��:�� �r �:� ��t c��-.� ., u/-• S'��'�/ z <br />��� Slate/Zip �� Phnne <br />Y �C��� �iU �>�S <br />"�GClL� — <br />Contract Price of Work <br />Contacl Person (Plan Review) <br />Descriplion of Work to Be Done: <br />; � . Lv � ',.,�..0 � �' �' �-'zz � ^ S:: �J ', .i.� <br />( i�� 1 � ��c �> �� � ��' �l � L-� l vl N' Cc �i c�n �� ��c' '� <br />NOTE: BE�RN �C WAYS MC OR AC CAB EUIRED TO <br />CITY dF EVERETT LOCAL SALES TAX CODE IS 3705 <br />1 hereby certi(y that 1 f�ave read anA examined this application and know the same to be frue and <br />con'ecL All pruvisions of la�vs and ordinar.�es goveming this type ol work will be completed <br />whether speci6ed herem or.noL The granfhig o( a pennit does not presume fo give authonty fo <br />violate or cancel the �roviswns ol any other state or local law regulating construcfion or the <br />perfonnance o� construcfion. That I am �ufhonzed by the owner of this �roperty to pedorm the <br />worlc lor which applicafion is made and 1 comply wifh fho State Contractors Law 18.27 RCW and <br />296.200 lNA C. <br />) �1 'l <br />. �-��' � � � '� � � i��) �L� <br />�_ _J �'�tiC� tin��� �u-�� � � _ 1 � <br />FEE <br />� • � � <br />J <br />