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ELECTRICAL PERMIT APPLICATION <br /> CITY QF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 3_(s/3 <br /> 425-257-8810 - FAX 425-257-8857-www.everettwa.org C(303`-�y Z <br /> ppP' '�'`TIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> �� c �3c���� Au�r <br /> PROJECT ADDRESS <br /> I,��ls ���0 1?c� &�x 2L�g C4C�s�a� Cf4 � �°��' <br /> OWner MailAddress City State/Lp Phone <br /> �-�Us ��� <<a�t �3co��wuy Au� �ver� (Nr� �i�2c� ( <br /> Tenant �GU�AQ¢re�Y Q� SO�.f.(,� Ciry Slale2p Phone <br /> t{ <br /> �e .• � 1���J�S�t (�'�o�-..TV-�tu�� lui� `�9273 �6crY2y-�3zs- <br /> EledriCal Con cfo� Mail ress City StatelZip Phone <br /> " �CA � ' <br /> Cp1� � L, �� <br /> ly J � <br /> Slate License Number Contrad Price of Work <br /> �� �� ��� ( �.r.�� 4 <br /> Proposed Use of Building Contact Person (Plan Review) <br /> Square footage(If residenlial new construction,remodel or addition) <br /> Descriplion o(Work to Be Done: <br /> tks-�wl�t 2 w �t S�y�s <br /> �j.�.S�''IJ'` � t M4v,.�.�'�'c`� 5 ��� <br /> NOT[: WIRING IN NON-DWEILINGS IS REQUIF2ED TO FEE <br /> �E IN P.ACEWAYS, MC OR AC CABLE. 'I 5D•�D <br /> CITY Of EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby ceRily fhaf I bave read and ezamined this apolicafion and know fhe same fo be Wo and � ��D 2� 1 <br /> conecf. A/l provisions ollaws and ordinances goveni�.ag this typo ol�vork�vill be completed 7 � v ` <br /> �t�hether speciGed herein or noL Tho granling oI a perm:f does nof piesumo fo give a�thor�ty fo <br /> violafo or cancel fhe provisions ol any ofher stafo or locaf law�egulating consVuclion or Ih� <br /> perlormance ol construcfion. Thaf 1 am aufhonzed by fhe owner o�lhis properiy ro pedorm the <br /> �vork lor which application is made and 1 comply wilh tho Sfafo Conlractors Law 78.27 RC W and <br /> I296200 WAC. <br /> � V�e�l,'�� 3- � - �3 <br /> Signaturo Dale <br />