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ELECTRICAL PERMIT APPLICATION <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 /> 1C �`f 13 3iZ-� H-o ��} '; <br /> PROJECT ADDRESS <br /> Lci�r>L PSAGrf✓T"S.�l �2�:1 6 �• A�c. �.rg, �3:a �.=�)Y(7"l 'c WIl '1t17 � 7 • ( - �l `l `t - IqyS <br /> Ownr.r Mail Address Ciry State2ip Phone <br /> �IZ- 1) l. 0(��� Il,o�l' I; �7�t.�/+v��74'Y EvF�Iv.�r w7} �15 :1.c1 <br /> TenBnt MailAddress City State2ip Phune <br /> � II�. ItE�s.-£ 5��6 iJ ��� 'y4- /�kltuf�h A't2. N. $/�-o�t,c-.L-iniE w11- 7�13S �i �-L - '; Yl - �:.; L�7 <br /> EleclricalContrador MailAddmss Cfry StetelZip Phone <br /> srt���ticsA ��� a.�_w yl� �(.� c �It � ��. o� <br /> Slale License Number ContraC Pnce of Work <br /> �-�,/-�#7=1� -T"t7iA ��'S Ur- lli>>,_ ,.�:c,�p <br /> Prop�sed Use of Buiiding Contacl Person (Plan Review) <br /> Descnption of Work lo Be Done: C- � �-"=`��T S 7- C�N�S 'T� �a.�U^ �� ,�. �i <br /> NOT E: WIRING IN NON•DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I henrby certily Ihat 1 have read and examined this apphcatiun and kno�v fhe same fo bo Wo and <br /> corr�et All provisions ollaws and ordinances�ovemmg fhis type ol worlc will be complefed <br /> whether specified herein ornot. The granfing ol a pennd doos no( r^swno to give aufhonty fo <br /> vrola.e or cancel the pravisions olany ofhor s1a(e oi iaallaw r.guP(ing consWction or tho <br /> pedcrmance ot construction. That!am authonzed 6y tha ownerollhis proporty fo pedonn Ihe <br /> work Ior which applicalion is made and I comply with fhe Sfate Contrectors Law 18.27 RCW and <br /> 296.:!00 WAC. (� <br /> i.�J <br /> �_-._ � �...�---� n � , � � o .� _;II " <br /> SipnaWre Dale 1��� <br />