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ELECTRICAL PERMIT APPLIC.ATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 987G1 /� '-�G''��z <br /> 425-257-8810 - FAX425-257-8857 -www.everetlwa.org �w�Z�� ,_OOZ <br /> qPPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM <br /> � , �, I <br /> �,; �-� i / r�c �� � , �, ; v� � � � i � <br /> PROJECT ADDRFSS <br /> � ` � , � <br /> �-l ,� ��` . l�'�� ���.� Cil SI^te/Zip Pl��one <br /> Ownef M3il Address Y <br /> �— City StatelZip Phone <br /> Tenanl Mad Address <br /> i � ! � / .� i� ' ./ ir . �J t � r, � <br /> r�Si i i� Y (� �� jZ /- �IS 'll <br /> � ���i U � ' � l�_-- <br /> �(� , ' �� — Slate�Z�p Phane <br /> 1—�— -'--,-� <br /> [ICCtricalCOniraClof Pdau�ddress C'ty � <br /> � �l C'J Ll � - <br /> ' ' niracl Price of Work <br /> Slale License Nwn�er <br /> i ����,� �.� i ` ��� ' l � -�I " �l � <br /> ' - Contact Person (Plan Review) <br /> : Proposed Use of Duilding <br /> � / - � <br /> �� 5quare Poolage(If residential new conslruction,�emode;or addilion) <br /> ' �� __ ;� o � ;,.��, < <1,� <<,�.� - ��ckn ��.v� — <br /> Ucscriplion of Work to 13e Done: � � <br /> eC�tl- G�� � l �CP� llil -`' �F��irc <br /> ; ��,�,i �'t 11 � c' i_i - �`�1� Sn1o[�� ��L_�.� <br /> ' I � 1 r f �,��\ rFe� cl���,_ri' �� t.� �i I ��1� o�,n �I <br /> � -�w��_�s�':i,.,sc__�� — <br /> NOTG B IRN�ZAC WAYS�MCC OR AC CAD�UIRED TO <br /> FEE <br /> ', CITY OF EVERETT LOCAL SALES TAX C�DE IS 9105 <br /> ' f hcmhy rerf�IY fh.d 1 havu�ead nnd exarnined fhis npl?lication and kno�v fAe sarno fo be huo and <br /> ' �;orrecl. All provisions a/lows nnrl ordmances ynvemmg Uus type ol�vork wiN bo completed <br /> �ehefher spr,r.ilicd heiein ornof. 1 ho y�nnfinrJ cl a pennd does not icsurne to grvo aufhonty to ,r� I, /�� � •� <br /> siuLde or canr,cl(ho vovisions ol nny ofhcr sfafc or/ocnl law re�uPtin9 cons(ruclwn nrtho ( v�, � � <br /> IpeAonnnnce ol cons��ucfion. 1ha11 ant authorited by fho o�vner ol thisp roperty to pe�lomi fho <br /> mork lor which��PPNcafion is mnde nnd I compty�rilh Ihe Sfefo C�nfrac/ois Law 1827 RCW nnA <br /> � 296 200 WAC. <br /> � <br /> � //- � I <br /> �...) I 0 Yti l� 1 aG.i.'Y�� - ' Dalo L� Z _—_._—. ___ <br /> ..-- " Signalure _ � <br /> � _---- <br />