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ELECTRICAL PERMIT APPLiCATlON <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 – www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />�P'l�Z�/Cq'Q� <br />�/3 D �%E,eGQE��v ��, t�L� v" <br />PROJECT ADDRESS <br />(3cuE �i� 6 7S �-N/R�.v�r�'KaYo•� <br />/�y,erN�,�S iNc N�c� Y�,ei� �Y — <br />Owner MailAddress /QO/7 Cily State2ip Phone <br />�T/D i'4� rr/30 �E,tt.etE.0 �✓AY FdF�E7r (✓A- �iS's�l <br />Tenant Mail Adtlress City StatelZip Phone <br />3[ o <br />G� Sr/�Ar�ivr Sda ,Esr-S,-H..s�ss.v �e�uRd� 4Jl�- �t�7'Z 7�y-7�� <br />Electrical Conlractor Mail Adtlress Ciry State2ip Phone <br />�� C T i �__ <br />State License Number <br />�_C�t ��-� � 'L —'– --- <br />Proposed U;e uf 6ui!ding <br />f � <br />_� 2 0 <br />Contrac Pcce of ork <br />��UH�%N,P� � <br />Contact Farson (Plan Feviaw) <br />Descriplion of Work to Be Do�e: /.�i/f %�-L L_ �r�' � �NE+ei2 � �T �" �� --. <br />NOTE: WirZING IN NON-DWEI_LINGS IS REQUIRED TO <br />BE IN RACEJVAYS, MC OR AC CAEtLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby certiiy thaf 1 have read ard exa�ni�;ed !his applicafion and know the same to be tiue and <br />coriecL All provisions of laws a�c ordirences governmg fhis typo of �vork �vill he complefed <br />whether s,oecdi?d ; iersin or nol. The granfing of a pennd doas not resume (o r�ive aufhonty fo <br />viola(e cr cancel the provisions oi cn}� e(her s(a(e or local law reguPOng construchon or the <br />performan�:e oi conshucGon. Thaf I am auth�rized by fhe ervr�r o/ this pioperty to peiform fhe <br />tvOrk (0l� i4i�iC1� eppliCBfiOl1 i5 mBdG aDd 1 COrllp y tVilh th9 StBfB ConU�ctors La�v 1827 RCWand <br />296.200 �.^.:4C. <br />��/ /�� d � <br />FEE <br />