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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 />��'I �. � % ���� �, <br />PROJECT ADDRESS <br />Owner <br />Tenanl <br />\�'��,t���;�i <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TU 4 PM <br />s;�1��.� <=*,,,. <br />Idail Address <br />A1ail Address <br />��..�L� � �, <br />Eleclri�al Conlractor ( Mail Address <br />� <br />�,'�'�L��T U�L."�"=�� i� <br />Stdle License Number <br />Proposr.ti Use ot �uildinp <br />Descriplion of Work l0 6e Done: <br />� <br />NOT[: 1NIRItJG IN NON-DW[LLINGS IS REQUIRED TO <br />5E IN RACFWAYS, tv1C OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br />\J ",4V �i\ <br />City <br />Ci(y <br />City <br />� <br />i�!� �,�� `, 1 �'.� - ��+���-� <br />u ,�L�� �_ — <br />SlalelZip <br />State/Zip <br />Phon� <br />Phone <br />Ii-1Lh 1!✓"/Z' ='IO-� ! <br />` , <br />StalclZip Phone <br />CoMrecl Price of Work <br />Gonlact Person (Plan Review� <br />;�� � C>C� - <br />I hereby certil}� thaf I ha�-e read and examined fhis applica(ion and know the same to be true and <br />correcL A!1 provisiens o! laws and ordinances goi�enung fn�s q-�e oi �,�o� �,�ai �� �o�„�i���d <br />�xheffter speci(�ed hercin or noL The �rantin� o( a perrnd does nof presurne fo give aufhonty to <br />violafe or cancel the provisions o! �viy other stafe orlocal law renulafing c�nslrucGon or fhe <br />pedennnnce ol constrYicfion. Thaf 1 am aufhorrzed by the o�vnei o/ fhis pwperty fo per(orm fhe <br />�rork lor rvhich application is made and I cornply ivifh the Stafe Contracfors Law 1827 RCIN and <br />296.200 INAC. <br />fEE <br />��. <br />�� (� <br />=;-�. ..��� �- , I �� I, � : J. <br />St�n�lnfe � �� Date I <br />