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ELECTRIC�L PERMIT APPLICATION <br /> CITY OF E�'ERETT 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 C{ ���j_D <br /> G o 704�-1�� <br /> �2_�c N �1vE�So�� .�5��?c� <br /> PROJECT ADDRESS <br /> I�+n-�l�o��� S�#le� 4a� +�1���,�, f31�c� Eve�c�E-�' w� q�zo� �z.3a,oi,�. <br /> Ownar Mall Addross City Slate/Zip Phone <br /> Tananl AtollAddress Cily SWta2ip Phonc <br /> Eleclrical Conlrocto� Mail AJd�ess Ciry Slale/Zip Pnone <br /> Sta�e Llconso Numbcr Contract Prico of Work <br /> ,�P��'wt`� ��5,�-G�u° <br /> Proposed Uso of Bulldin9 Contacl Porson (Plan Raviow) <br /> Descriplion af Work to C�o Donc: _ NL"� ?�� �'tV�\� �Q�1 e 1 <br /> NOTE: WIRING IN NON-DWELLINGS IS RFQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAI SALES TAX CODE IS J105 <br /> 1 he�eGy certily fhat 1 hava rend and examinad Ihis application end know fhe same fo bo fruo and <br /> convct. All provisions ollews and ordinances govommg fhis fype ol work will bo cornplefed <br /> N hether specilied herein or noL Tho pranfing o!a ponnd does nat presurno lo give authonty fo <br /> violafu or cancol the provi�ions ol any ofhor stnto or local law nar�ulofing conshuction or tho <br /> porforrnance al consl�uction. Th�f 1 am nuthonzed by fho owner o/fh�s property to pedomi fhe <br /> rrork lor which opplir.ofion is rnado and I comply wifh fho Stafe Confrsc(ors Law 18.27 RCW and <br /> 196.200�WAC. r— <br /> � -{ <br /> � � < <br /> ="-k��� � ��n;� ' �I I � � � �b 01 �� <br /> ,i�nawre -� Dat / / <br /> ^//1`1 _ / l _/ <br /> / J <br />