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! <br /> _ � <br /> ELECTRICAL PERMIT APPLICATION <br /> CI'TY OF EVERETT' PERMIT SERVICES <br /> 3200 CEDAR STREET, EVEP.ETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8!+M TO 4 PM - DEBIT 8�CREDIT CARDS ARE NOT ACCEPTED <br /> y9! 9 Evev9reeh ►_�� <br /> PROJECT ADDRESS <br /> f�lA1Q 61FC^ a81�3 yi�'z,Ss <br /> �st n�t, au c.►c s �{9 I� �v6�lr�c�t� " t ��-�'_I l�l� <br /> Owner Mail Address City Statel7Jp Phone <br /> �TARBuc.k 5 `1919 EUerarcer. wM f�.eH'� I�M �61�03 yzS' Zs8 S95If <br /> Tenant MaU Address City Slate2p Phone <br /> s��R�r�N �c�na,� cLc3 �ws ��. s s�att�� w � �a�a9 u��x,3�w <br /> Electrical Contractor Mzil Address City Stale2lp Phone <br /> � <br /> SVr1�.Te� 2Za �0 5U0 <br /> SWte License Number Contract Price of Work <br /> �A1+41►'IGVc.1a � ��.LThI L l�/v�`l <br /> Proposed Use of Building Contact Person (Plan Review) <br /> Description of Worlc to Be Done: Dl S CftY1Yl GL� � Q� CMY1e e_T. _�t+We 2 �� <br /> C � t �+�1��f <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN R.4CEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby ceRi(y that I have read and examined fhis application and know the same to 6e true and <br /> correct. All provisions o(laws and ordinances governing this type o(work will be completed <br /> whether sFecified herein or not. The granting of a permit does notp resume to give authority to <br /> violate or cancel the provisions of any ofher st�te ur Iocal law regulating construction or the <br /> perfcrmance of construchon. That I am authonzed by the owner ol this property fo peAorm the <br /> work for which application is made and I comply wifh fhe State Contrac(ors Law 18.27 RCW and <br /> 296.200 WAC. <br /> y ^ / �-� ` <br /> Signa� r Date � <br /> r� <br /> � � :%o �� � <br /> �� <br />