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ELECTI�ICAL PERMIT APPLICATION <br /> CITY OF EVEIZETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org � `a 5...()-��' <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM T04 PM L�O���/(7"Z_ <br /> �7/,, /}� S� _ <br /> PROJECT ADDRESS <br /> ��y���.c� ���1�� <br /> Owner Mail Address Cily Slale/Zip Phone <br /> Tenanl Mail Address Ciry Stafe/Zip Phone <br /> '�l`����`��� <br /> _7"//us���,r`�%1nf��"lrc, �.z�33�/f��=�✓c•�rf� ,�!/ �] z�,/f�LI-�T(,L� %3/�(� <br /> E�eclrical CoNraclor Mail Address City StatclZip Phone <br /> //l�r� �f��l�G ���� <br /> State License Number Coniracl Price of 1Nork <br /> Proposcd Use ol Buildin� Conlacl Person (Plan Review) <br /> � ,/� / <br /> Oescription of Work l0 6e Done: _,���� 6 �� ,J!//(�iJ�{/ ��G�L//'� � <br /> Y� <br /> L�s.-�.— <br /> � - <br /> I <br /> NOTL: WIRING IN NON-DVVELLINGS IS REQUIRED TO FEE <br /> C�E IN RACEWAYS, MC OR AC CAf3LE. <br /> CITY OF EVERETf LOCAL SALES TAX CODE IS 3105 <br /> I hereby certily(hat I Iiave read and examined tliis application anU kno�v the same to be true and <br /> correct. All pro��isions olla�vs and ordinances govenung fhis typo al u�ork will be comple(ed <br /> v,liefher spec�Ned herein or neL The�ranting o(n pernuf does nof �resume fo gire aufhonf}�tu <br /> violafe or cancel the p�ovisions el any other state or local la�ti�regulafing consVuc6on or the <br /> perlorrnance o/consfruction. That 1 am au(horized b}�the owner e/fhis property fo perlorm fhe <br /> �sork lor�vhich applicafion is made and 1 compl}�u�ith fhe State Confrac(ors Law 18.27 RCW and <br /> 296200 WAC. <br /> —�'" ��'r�� n ,I b2/ <br /> Si�n.riure Da�e � ��� <br /> l <br />