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10IN5?2�fe�`t 03: 35 253b352027 REMI_D PA6E 03/B3 <br /> 1, <br /> ELECTRICAL PERMIT APPLICATION <br /> CfTY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857—www.everettwa.org <br /> APPLiCATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> �,18a�A,-����� 5Zd <br /> PROJECT ADDRE3S <br /> t�ac�,��L �-er��� Z,Z,� � 65 33� S�.v:�s ������1 <br /> Owne� MallA�fesS City Staterzip Phone <br /> �-i� ii8a� ,-�,�� i�.�i ��e�e� � ,��C�a`f <br /> Tena�t MailAdtlrecc Ciry Sbte2ip Pnme <br /> �Prn;-� ��ec.�rcc� ! �i�-119 SE �f�'' S+ ker��- t.vl� R�U�(�1 2�3-6?�. . <br /> EIOCItiC21COnV9dor MaIIAAtlreac - City SlatefZip � Phone <br /> 12em � del �ii� 61 , -�' -�r> �0� � <br /> Stete License Numper ContreG Pnce of Work <br /> el�,�,�,�c�f up�r� ��2cj ���� tl ;arr1,�S zs3 8d��� <br /> P�oposed Use of Buiitling Contact Pgf50n (Plan Ra�ieW) <br /> Description of Work to Be Done� (1`Q,�'t�"� �—� �/.���� I <br /> � <br /> NOTE WIRING IN NON-DWELLINGS IS REQUIRF_D TO FEE <br /> BE iN RACEWAYS, MC OR AC CABLE �D �%� <br /> CITv Of EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cert�fy that I have reatl and examinetl lhis application antl know the same to be frve and �C>"( �.O 'C��\ <br /> conecf All p�oViSions o(18ws and prdina��Cec govemmg this type o/wodr wilf be rnmpl6ted <br /> wrre�ner specified he�ein or no[ Tne gran6n�of s pe�mil does notp iesume fo give aufhonty ro <br /> vi0late olCancel the p�Dvis�onc Of H�y ofhBr State of lOcal law rggulahng construC(ron or the <br /> peAorma^ce o1 consfrt�ct�on Thet I am authonzed by tns owner oI thrs pmperty to pedomr the <br /> work for svhich applica�ion is made and I compty with the Stafs Conlr2cYors Law 78.2�RCW and <br /> 296 WAC. <br /> �-U�d.,l,�.� <br /> Iu - S�o� <br /> Signature Date <br />