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��w <br />ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EV[RETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - �v�vw everettwa.org � d� 3—/ Z <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />� � ✓ i�i <br />P OJECTADDRESS <br />�,? �S ?- �� <br />O�vne� Idail Address City <br />Tenan� <br />�L�,�/. <br />[ledrical Conlractor <br />M11a�l /lddiess <br />S � �F� , J3% ,�� <br />Mad Address <br />� ^C�IY Ci 1� `r� � //` / <br />'Y <br />Sta e License Number <br />�l� Y Cl, i ����i. <br />Proposed Use o( Buildiny � <br />� �DJ <br />City <br />Cdy <br />State2ip <br />SlatelZ�p <br />s� ����r� -S; <br />-- si,ce�n� <br />C�!'z/(7 —O�% <br />Phane <br />Phana <br />�Ik'�� <br />Phone <br />4/l/i/�, � <br />Conlracl Prica of Work <br />Contact Person (Plan Reviev�) <br />Square Foo�age Qf residential new construclwn, remodel or ;+dJition) <br />�L 1� + C _ �,�•'`�' __1 �'>a� <br />Descrip�ion ol Work lo [ie Dono: ___ <br />� NOTE W�RING IN NON-DWELLINGS IS R[QUIR[D TO <br />6C IN RACEWAYS, h1C Oi2 AC Ci1�l_E . <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hmeby cci��ly Ihal I Irtrvo io��d �ind erantined (his �ippli��alion und 6nu�•� fhe sunro (o bo I�uc and <br />conect. 1111 p�avisions ull�uvs nncl o�dm;vtces �ovr.ming this (ype o/ u'�ik �•.i�l be compleled <br />�vhefhcr spccdied Rwcin or noL !he yranling ol a permd does not/��esunm tu yive aulAoiity (o <br />violnf^ or c��n �!hc �navisions o/ any olhur sfa(e or local Imv regu nfing construcfron ar the <br />perfonnanc oI cQrisfiuction. T h�t I am airthorir.ed by Iha o�'✓ner ol (liis I��operiy fo pe�ionn tho <br />woik lor w ich applicafion is,madc and I conr � wfh tho Sfalc Gontrar.to�s Law 18,2! RCW and <br />295200 ✓AC. / � <br />i � <br />, ' /l' �� ��/�- <br />, <br />, / <br />4 <br />. . __—_ ____—___- <br />- _______-_____— <br />-__- _ _. -_. . _ <br />____� _. _�..._ - - Ualc <br />FEE <br /><�J �i L> <br />(� �� <br />r-:�L►�-��� <br />