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EL�CTRICAL PER111I11' I��PLICAT'IOf�J <br />CITY OF EVERETT I'ERMlT 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 />'-� `� �� � ���E w�S� <br />PROJECT ADDRESS <br />L-(=t�N.9 (�� �ti/�}�NdyL <br />Owner Mail Address City <br />S�alelZip <br />Phone <br />�a �•,� W� R-rvv��. �' � I 7''' Avc wE>�r �✓ �,q- 9� <br />Tenant <br />Mai! Address Cily State2ip Phone <br />El.tir ��r -�<< '-�Jiz �s7�` s� N�1 Si�w�-��n _ �M�- 9�,��.�1�r�93-8° <br />[leclrical Contraclor <br />MailAddress Cdy SlatelZip Phone <br />�I?;��` r9sG�� <br />Slate License Number <br />�r��' v�,,.c� <br />Proposed I.�se of Building <br />Square Footage Qf residential nev✓ conslrucli�n, remodel or addition) <br />� `�Uo. GO <br />Coniract Price of Work <br />Contact Person (Plan Review) <br />Description of Work to Be Done: �� /�I�t� �����'� �"� v���1 SU ST� �_ <br />NOTE: BERN AC WAY9 MC OR ACI CA� 4UIR[D TO <br />CITY OF FVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceRi(y lhat 1 have rc-ad and exprnined this application andof ��ork��eill be complete� `�nd <br />correct All promsions o(/atvs and ordmances govemntg fhis fyp <br />��,dietherspecifir.d herein ornoL The granfing o(a permd does notp resunte ta give au(honty fo <br />violate orcancr,l (he provisions of any ofher stafe orloc�lla�•� regula6ng construc(ion or the <br />pedornrance of construction. That I am authorize�l by tlre on�ner of lhis pioperty to per(omi fhe <br />u�ork for �vhich application is made and I comply wdh the State Contrac(ors Lar✓ 1827 RCW and <br />FEE <br />� i�%�- -I33 <br />