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�. (_ <br /> ��� ���T <br /> ELECTRICAL PERMIT APPLICATiQN <br /> CITY OF EVERETT PERMIT SERVIC�S <br /> 3200 CEDAR STREET, EVERETT, WA 98201 /, `,� � 6 <br /> 425-257-8810 - FAX 425-257-8857—www.everettwa.org `r <br /> APF'LICATIONS ARE ACCEPTED FROM 8 RM TO 4 PM V'�6 D�{ `�I � <br /> I��j,_�� ��1�1 �„u.���������,�1 <br /> PROJECT ADDRESS <br /> T-I^��'r,l �% I ��I-�)ri���� �k��a/ IU 1�ql I �ll�- ��11 � <br /> Owner MailAddress Cily Stale/Zip Phone <br /> � � � �-� ��� ��i I <br /> 'r i��il���'��(� ���" 111 (lvPl� ' � <br /> Tenanl MailAddress City State2ip Qhone <br /> � , � � ; � � � � � I ' e � _ �u�') <br /> Elecl cal Contractor Mail Address Cily Stale2�p '��'�" <br /> � 1���'�� `N' <br /> �}'�2 i�5�1<X�o 1�1 � ) � <br /> State Li ense Number Conlracl Price of Work ^� � ��— <br /> ��,�`= � '. <br /> ��� � ���=- _ � � � �ir��t�� ��<<,�.�, <br /> Proposed Use of Building Contacl Person (Plan Review) <br /> �� -� U C�._ <br /> Descriplion of Work to Be Dune: � <br /> ' � r�' �l'��;i' � � � � — i <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. I , .� �� <br /> lL�� � <br /> CITY OF EVERETT LOCAL SAIES TAX CODE IS 3105 <br /> 1 hereby ce�iily(hat I have rvad and examined fhis application and/aio�v Ihe sarne fo be frue and <br /> conecG All provisiais o/laws and oNinances goveming this type of�vork�vill be cornpleted <br /> whelher specified herein or not The gnnting o/a pemuf does not resume fo give authonty to <br /> violate or cancel the provisions of any other state or local law reyuPting constniction or the <br /> pedommnce o(consinicfion. That 1 am aufhonzed by fhe ownero/this property to pedonn the <br /> work!or which app6cation is made and I compty�vi(h the State Contractors Law 18.27 RC W and <br /> 296200 W.4C. <br /> �/) in,�0� �/ I i��/�/� `t'� � l��I%J <br /> � Signa ure D te <br /> i <br /> �0�'- i% �-� <br />