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ELEC�'RICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 9820� <br />425-257-8810 - FAX 425-257-8857 — www•everettwa.org <br />ppPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />� // _ <br />�`/ � S�4 <br />-1�� -�J7 <br />PROJECT ADDRESS <br />Tr.nnnl <br />� <br />Eloc�rical Conlractor <br />�>l/,�b -/�7.�'j� S�- �l%�u�l <br />Mail Address <br />Mail Addioss <br />-,� : r.:�:k <br />Mall AACross <br />City <br />Gly <br />i�t�l% ��'��'' 'r�s���g3v <br />SlatdZip Phone <br />SlatdZip <br />Phona <br />,ti.<� 9�a3 ��-{�3j� �j� � <br />Slale/Zip Phone <br />1 5 Lt"- �` <br />��4,b\ "C��i�il� � - Contr ct k <br />Stalo Uconse Number <br />/✓ � <br />� �---- <br />Conlar. � Pmsnn (Plan Revicw) <br />Propased Usa of Building <br />/� � <br />(� �' ' .y>( �lu� .��'"� --- - <br />Dc.:ciiplion o( Work lo �c Uona: _ <br />NOTE. aERN RAC WAYS, MC OR AC CAB �UIRED TO <br />CITY OF EVERETT LOCAL SALES TAX CODt IS 3105 <br />ro�n> ty NI p/rovisfons o/ la vs and ort/inances 9oveininq fhis typo ol �wo� �will bo ca/ nplefed Flnd <br />vllol fe or cari�cel (lie ��ovfsio�s of o^y othcr �fafo oi local nw ropulflflll[J GOOSfNCIl0f110l�O �ty fo <br />porfomiancA of cons�iuclion Tlmf � am nuthonzed.by fho ownor o! Ihis proporty fo porlomt tho <br />79f,k200�WAC.���phcnhon �s mado and 1 comply ��th tlio Sfafo Confracfors La�v 1H.27 RCW and <br />��.�_l���Vl��141[l� — � Date � � — <br />7 Igna�ure <br />FEE <br />oU�,� p4 <br />i I <br />� <br />