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ELECTRI�AL PERMIT APPLICA7fON <br />CITY OF EVERETT PERMiT SERVICES <br />3200 CEDAR STREHT, EVERETf. WA 98201 <br />425-257-8810 - FAX 425•257-8857 — www.everettwa.org <br />APPLICA710NS ARE ACCEPTED FROM b AM TO 4 PM <br />�� 3�� sr <br />PROJECT A�DR[SS <br />r� <br />Owner <br />Tenant <br />�i�L.l�,u.Oklf._ .S, <br />Eloctrlcal Conuactor <br />Mall Addraae <br />Mall Addrwa <br />(vtall Aadro6E <br />L.i4 .l / LM <br />State License Nl:mber <br />-��� s� �� ��°: <br />��ry suce2ta <br />Ciry SYateG'��•� <br />.�F� �--- <br />proposed use of Bullding , <br />Clly <br />S�ate/7�D <br />�o-t <br />Convact Price of Work <br />i <br />7 .�S <br />�sz <br />y�49 <br />Phone <br />j� Phone <br />Contect Person (Plan Ravlaw) <br />DescripUon of Worfc to Be Dona; r41� /� � r/-�S1 � � �Dr� �� <br />NOTE: �ERN �CEWAYS MC GR AC CABLEUIRED TO <br />CI7Y OF EVERETT LOCAL SALES TAX COOE IS 3105 <br />I hereby cerNfy thet 1 have rt9ad artd exemlr <br />correot• A11 provisfons oflaws end ordlnen� <br />whetherspecllledherelnornot. ThepronL <br />vlolate or canc�! ihe pruvisiors o/ any othe <br />^vekf�oiwhl ch eppllcetlon�ls mt �e and I a <br />2ss.2oo w,ac. <br />�.�. ���,-� <br />FEE • <br />3S-o e <br />to be truo end <br />omplefed <br />> aufhoritY t0 <br />entl <br />% - � i�' <br />s�. � i�� <br />