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.� _* � <br /> ELE�TRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-�57-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCcPTcD <br /> SS o � ,L r �z rce e r� 1�.� <br /> PROJECT ADDRESS <br /> S te ��. R, �� �F� ,.� PO E�,� 383� �'��.�" l,c)a , ��'2.u.� y7s-3s'3->Pdl <br /> Owner Mail Address City State2ip Phone <br /> �N 1 Cr<I R� S C �Ctil 4 C-r� S 5 o S E.w.X-� wa <br /> Tenant Mail Addres� C!ly � Slale2ip Phone <br /> 2u 6ZS S 9t� pUC. � � lNc,�:��Nvi � IC Wa 98J72 �:,i-xi9S78f <br /> Electrical Conl�aclor Mail AdCress Ciry SlateTGip Phone <br /> �� � ���- os � <br /> e u s � w� ��o a k �'`�-`,�>>� / ,.,/��� o • — <br /> State License Numb r Conlract Price of Work <br /> �� R n.�Nf�. ( 1��..k�.. � f�c �: <br /> Proposed Use of Building � Contact Person (Flan Review) <br /> Description of�Nork to Be Done: b �;;J P. -t �c. l �- �'`� � �rA'� <br /> � � — <br /> NOTE: �VIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEVVAYS, MC OR AC CABLE. <br /> � <br /> CiTY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certi(y that I have re�d and er.sr�ned this app/ication and know the same to 6e true and <br /> cerrect. All provisions of laws and ordinances governing this type o/work will be complete� <br /> whether speci(ed herein or not. The grantin�o/a perm�t does notp resurne;o give aufhonty to <br /> violate or cancel the provisions o(any othe�state or local/aw regulating cnnstruction or the � <br /> per/ormance of construchon. That I am ar�thodzed by the owner of this property to peAorm the <br /> work for which application is made and 1 r:omply with the State Con6actors Law 18.27 RCW and I <br /> 29b.200 WAC. <br /> � /�/L,� �1 /2 � �+ <br /> Signature D te <br /> �c� �f �� �7 S <br />