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ELECTRICAL PERMIT �1PPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 C[DAR STRE[T, [VERETT, WA 98201 �_ a4 —/Z <br />425-257-8810 - FAX 425-257-8857 —�wew evereltwa.org C J ZO��ll7 <br />APPLICATIONS ARF. ACCEPTED FROM 8 AM TO 4 PM <br />-, , � �(n, _ , <br />r <br />� � � `�� ��'�- <br />PROJECT ADDRESS <br />L; �'_f _ '� -;u , ;-: ��'r��'-1 4 i: � i :� �-- � _� i � ; /-����- <br />� �. � <br />Ownef A9ail Address Cily <br />Tenant <br />E�ec�rical Contractor <br />Slalo License Num6er <br />IPraposed Use of l3uildinc� <br />I✓ta�l Addiess <br />A1ail Address <br />� Squ2re Pootage (If residential new consiruclion, iemodel or addition) <br />Cdy <br />CAy <br />.��_,��� <br />StalelLp <br />Slale/Lp <br />Slate�Zip <br />Comract Pnce of Work <br />-'�`� y7t' ?�IY <br />Phone <br />Conlact Person (Plan Review) <br />Phone <br />Phone <br />� Descriplion of Work la �e Done: �i� �'� f���� �� "— <br />NOTE WII�ING IN NON-DWGLLINGS IS R[QUIRPD IO <br />i l3L IN RACEWAYS, MC OR AL' CADI �. <br />CITY OF EVERETT LOCAL SALES TAX COD[ IS 9105 <br />I hemby r,crtil� fhdif I hare mad nnd evmnined Ihis applicnlion anJ hnu�v tlic ;anw fo be fruc , nd <br />r.onect. NI prnvrsions �/ la�vs nnd orduvinces ynve�nfng llus type o/wo�k �ti-�ll ae conrpleted <br />�shefhr.r spr,cilir,d hcrem ornof. 1 he gn, nfiny u/ a penrut docs nof/vesume fo give aufhanty to <br />violafe nr r;ancel (ho /novisions ol ��ny olher sfa(o or local Imv myu abn� constn�cfion or Iho <br />pwlonmmco ol conslrucfion. That I am nufhorized by f0e owncr ol flus�voperly to palorm fho <br />arork lur �vhich dipplica(ion is nr�dc and I comply �vifh Ihe Stnfo Canf�ac o�s I. ��v 18 27 RCW and <br />296 200 WAC. <br />, .�.,,��.,�� <br />i l:'v lr ` <br />— -- ir�io <br />__ _---- -- - - <br />F[[ � <br />� <br />L� <br />f�l 2�� - I 1 � <br />