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i <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, VYA 98201 <br /> 425-257-8810 - FAX 425-257-8857-www.everettwa.org /b _aG y0� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM L�o g ,�. � aa <br /> � � �� � ��� X'� � �a <br /> PROJECT ADDRESS <br /> �� � I �711 N �c S��(I l�i ��c� S 7 k '�.�:�a�/ <br /> Owne� Mail Address Ciry Slate/Zip Phone <br /> � I j , <br /> � II Si�a � "'� �C 1 � �5 �5 A��^„�f ���ff r�.�f� `k�anv <br /> Tenant Mail Address Ciry State�Zip Phone <br /> ��'�J , <br /> S � z i � .(,,� i ' � � �r7 /3(1C% <br /> ;�i��1�� C �NCI`(i<' �/�'K �J���S KeC"�C" �`Cl i7l'cu W {� .�.� 3 �� .7 <br /> EleCiriCalCOntractOr MailAddress City StalelZip Phone <br /> �� -fi � I�f� 3)� ����o <br /> i( it i r <br /> Sta?e Lcense N��mber Contract Price of Work <br /> Proposed Use of Building Contact Person (Plan Revi�w) <br /> Description of Work to Be Done: - nS /t��l U l ��� �� � � r'�� lS '` ( �"�J (J�'�Cl�,f,r1v%it-/ <br /> �l <br /> �ti ` ��Ir � � �'�� �l-l�.r- �i^�� t <br /> NOTE: WIRING IN NON-�WELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITV OF EVERETT L4CAL SP.!ES?AX CQDE IS 31^5 �QcYIO ' I�"� <br /> I hereby certify that 1 have read and examined this application and know fhe same to be true and <br /> correct. All provisions o/IaH�s and ordinances goveming this type o/woB will be completed <br /> whether speci/ied herein or noL The granting of a permrt does notp resume to give aulhonty to . <br /> violate or cancel the provisions olany ofher state or local law regulating construction or the <br /> peAormance of construction. That I am authorized by tbe owner o!this property to perlorm the <br /> work/or which application is made and 1 comply with the State Contracfors Law 78.27 RCW and <br /> 296.200 WAC. , _ ,.,> <br /> �%�' <br /> J�•_Z�/ '_ C�r� <br /> SignaWre - Date <br />