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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 8 AM TO 4 PM <br />dSi`� <br />�� �� �� A�'� <br />PROJECT ADDRESS <br />Owner <br />Tenanl <br />��:�1 � <br />Electrical CoNraclor <br />R� � Y' <br />Mail Address <br />hiail Address <br />tdail Addre�> <br />�/��—t�-�`��� � ����� L.7 <br />Stale License Number <br />L'•-'iF � \ L c — <br />Proposcd Use of Buildin� <br />DPscriplion of Work to Be Done: <br />1 <br />NOTE: B IRN �AC[WAYS � C OR AC CAB �UIRED TO <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />��nu}, <br />Ail n�c <br />or <br />City <br />City <br />Cily <br />�_��?-oq <br />L 090 Z -.o� <br />,s���� �-S <br />Slatel7ip <br />State/Zip <br />SWte'Zip <br />Phone <br />Phanc <br />% —Z� 7 <br />phone <br />�/�/r���+�y ��h <br />f3- J / " / `-�l_./ �. <br />Contract Price o( Work <br />Conlact P2rson (Plan Reviev+) <br />�at I harc read and exnrn�n�J this ��pplication and kno�i� the sarne to be true and <br />sions o! la�vs and ���':nances qovenung Ihis type o( �+'o�k u�ill Ue comp�eled <br />1 herein or. noL The y: anfing ol a penmt does not pieswre to give aidhurrty fo <br />fhe provisions o( any other state or local la�v re�ulaCng conslruction or fhe <br />onsVuchon. That I am aulho�ized by fne o�vner o, this property to peAorrn fhe <br />,r�licatiora is made and I comply wdh fhe Stafe Canfracl�rs ( a�v 18.27 RC W and <br />— s����,n,��� — <br />FEE <br />� oiu2 - �k � <br />