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ELECT641CAL PERMIT APPLICATION <br />CITY OF EVERETT PER�IT SERVICES <br />3200 CEDAR STKEET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 —www•everettwa.org <br />APPLICATIONS ARE ACCEPiED FROM 8 AM TO 4 PM <br />�p�� ��ev�rP�.+ti W0.`I — <br />PROJECT ADDRESS <br />�vb<i� 5 <br />Owner <br />Tenant <br />���� ����,��� <br />Electrical Contractor <br />Mail Address <br />� �3 33� <br />Mail Address <br />��1 i,, l � ZS L�S'-f ,T �Z <br />Stale License Number <br />Proposed Use of Building <br />Square Footage (If residentiai nevo conslruclion, remodel or addition) <br />Description of Work to Be Done: e I 0. C� <br />W <br />t� �e-�-e-Fj- � I� <br />City Slate/Zip <br />��ry Slale2ip <br />�v rZedMo�� �A <br />ra,. Slate/Zip <br />ia—ao—�a <br />��a�a-iaz <br />Phone <br />Phone <br />yzs- � 7� <br />4 f 73 <br />Phone <br />c� <br />SODD. <br />Contract Price of Work <br />(�i' � � �dC�l�'lGti � <br />Contact Person (Plan Review) <br />I2 -�IU a,re�e_t,� <br />� <br />NOTE: BERN RAC WAYS MC OR ACICAB4UIRED TO <br />L E' �i <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby certily that I have read and examined thrs app/ication and hnow the same to be true and <br />correct. A/l provisions of la�vs and ordinances goveming fhis type olv✓ork tiaill be, complefed <br />�vhetherspecified herein ornoL Tne granting of a pennd does not� resume to give authonty fo <br />violate or cancel the provisions ol any ofherstate orfocalla�v regulating conslruction orfhe <br />peAormance o(construcfion. That 1 am authonzed by the ovmerof this propeRy to peAorm the <br />r: ork (or vihich application is made and 1 comply v�ifh the Sta(e Contractors Law 18.27 RCW and <br />296.200 WAC. <br />�� � <br />Iz/l�/I= <br />�OX <br />rod-�� . <br />FEE <br />��o �� <br />� I � ��— � �` <br />