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� <br /> 5�.:�. q- ���, n��s <br /> ELECTRICAL PERMIT APPLI�ATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETf, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> i� /�'/-� <br /> ��ilq 1q� Ya�-es�, Bldc�.� �1�-�� <br /> PROJECT ADDRESS <br /> 1�!a r�� n�. S OI u o.�e 2.,.avs�i.-e-.-�s i�o f 3ox 1�S `1 S r,o Y.�n,:s 1. W A °I B d�1 I <br /> Owner Mail Address City Slate/Zip Phone <br /> �100 , A\o5 <br /> Tenant Mail Address City State/Zip Phone <br /> D ' p n r� � 1 T tias <br /> rJ�Ch0.�t1�CWC o��1�g �D�O� �ue ��o2u� �IOW�I�Ia�(RIOff nlAWl� q`60u� '77L1-S�1 � <br /> Elecl�Contractor Mail Address City State2ip Phone <br /> 01..y ►n� ��oap , so . �' <br /> State License Number Contract Price of Work <br /> �R'�' tn�� � , O� �i CR �v1n _ 1�m 1 uRX <br /> Proposed Use of uilding Conlact Pers (P�an Review) <br /> Description of Work la Be Done: � r�y�� s �T' (tiJl 'f;r�S��1..�, <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 � `� `�1� i� <br /> � � <br /> 1 hereby certi(y that I have read and examined this applicafion and know the same to be true an � � <br /> correct. All provisions ollaws and ordinances goveminy th�s type oI work wi116e completed •�QQS <br /> whether speci6ed herein or noL The g�anting o7 a permd does not presume fo give authonty to � <br /> violate or cancel fhe provisions of any other state orlocal Id.v regu/ating construchon or the AUG l <br /> pedormance o/cons7uchon. Thaf/am authonzed by the owner ol this propeRy to pedorm the Z�:,\� <br /> �vork for�vhich application is made and I comply with the Sfate Contractors Law 18.27 RCW and �J 1'•� <br /> 296.200 WAC. �.{ l)� �'��vi�c� <br /> C� p,;c�v�� . <br /> �� DS <br /> S' a ure �at <br /> l�;��— � � / <br />