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ELECTRICAL PERMIT APPL9CATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, N/A 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS PRE ACCEPTED FROM 8 AM TO 4 PM <br />t.-.�' ,.i �� � i � ��� p �) <br />l <br />PROJECT ADDRESS <br />I <br />1 � � ��- ;� C. � i. �, <br />\ <br />Owner � <br />( <br />Tenant <br />�;�= C L� �ii ! <br />Eleclrical Contractor <br />��f <br />���., � / � ��J ,� I r L � � �) <br />b <br />MailAddress <br />Mail Address <br />t'-, i: :- _ L L l�� I; <br />����,�,,. <'�'�,���.��=L�(��''C� �/ �3 <br />State License Number <br />�� � �-r 1� <br />Proposed Use of Building <br />Square Footage Qf residential nee� consiruclion, remodel or addition) <br />City <br />Ciry <br />cry <br />Stale2ip <br />StalelZip <br />'1 � � , �� c;�;, <br />�a� �� �, �.. <br />SlatelZip <br />Coniract Price of Work <br />Cnntact Person (Plan Revie�•�) <br />� � � � �' �^�'�T <br />Description of Work to Be Done: ' ��L' — � - '� � � �l � � �� �� � � L � � � <br />�"� i_� l ' � i� � ( � � I � �! � i (' T � /f.L. � <br />NOTE: V�9RING IN NON-DWELLINGS IS REQUIRED TO <br />BE IN RACEWAYS, MC OR AC CAf3LE. <br />C�TY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby certi(y that 1 have read and examined fhis application and kno��� fhe same (o be true and <br />correcf. All p�ovisions of la�vs and ordm�nces governing this type of r:ork �rill be compfeted <br />c�hetherspeci�ed herein ornoC The granfing of a perrrd does not resume to give authonty to <br />violate orcancel the prov�sions o(any othersta(e orlocalla�v reguPting construc(ion orfhe <br />pe�formance ol construchon. 1 hat I am authorize� Gy (he o�vnerol this properiy to perform Ihe <br />r: ork (or whic6 applicafion is made and 1 comply ���dh (ne State ConUac(ors Lav� 18.27 RCW and <br />296.200 WAC. <br />� - � / �7 <br />v`�+ �.�� ��' <%, <br />SignaWra � uaie <br />/=� <br />FEE <br />Phone <br />Phone <br />I'hone <br />