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� <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 4?5•257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM • DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> � �,tl• P�tSrNu ,t� �� w�- 9�1� <br /> PROJECT ADDRESS <br /> SInm2� Plwno <br /> Owner Mail Adarrss �'�1' P <br /> /y/(� Qi� w c�rs�•�� �4 6d�¢c�ss' w�" qzc—•29e•69 <br /> �1 M�� �' � ' r Cit �Inlu/Zip Pltano <br /> TenaM MailAddmss Y <br /> �{Zr•'�0� <br /> A+)r /�OzY' ti.b�/-Gc�..�4.►�� /J �'o� g��/ Gv/r 98��/ 9�F2— <br /> Electricifl CoMractor M:�il AAdmss Cily <br /> SlalolZip PMne <br /> ,qI'1I' SEs1"y132�s i?o°� <br /> Contrecl Price ol Work <br /> S�ete License Number <br /> ��Y��rarT! '�LS-tf02•�i33 4 <br /> '�'�'�'^'��� Contact Person (Plan Review) <br /> Proposed Use ol 9wlding <br /> Descnplion of Work to Po Done�. <br /> �✓S7�w� 96�-u2iTY sysl�• �J h'EIJIYI�c.. OsFicB if�RE'/� <br /> .j,,,� �„e�csnda �eoa.«s . <br /> NOTE: BERN RACEWAY3WMC OR AC CAB���IRED TO <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hcreby cortily that 1 havc re�d nnd exemined fhis npPhr,afion nnA know fhe sama fu be hue xnA <br /> correcf. All provisions o/Inw,end orAinences governmg fhi�type opl work will ba comple!fod <br /> W olafePnr cance)U cepre�v/sions o!un 9ofher sfel Aor I�al��w mgulaf�g eonsln9cflon o 6fhey fo <br /> perloimence ol conslrucfiun. Thaf 1 em eulhonrad by fhe owne�of fhis property fo perfomt fhe <br /> work lor which npplicnlion is m.iAe anA I complY wrth the Stafc Confmcfors Law iB27 RCW enA <br /> 296 200 WAC. <br /> _ �'�� 3 I��°' _ <br /> � � <br /> Uale <br /> —�S�gnelure <br /> •''�� ) � � �'� <br /> . � <br />