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-� ..__` <br /> ELECTRICAL PERMIT AI�PLICATION <br /> CITY OF EVER�TT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 -�vww.everettwa.org <br /> APPLICA710NS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> 5 / a � �Jr., � nT�•� -1 <br /> PROJECT ADDRESS <br /> �l.on Ik�rn ��� �� Sl.1 / /3r�� o ..,.., � C� l4 �b,Ici •/!S`�?51•GdG7 <br /> C �..: �1 , <br /> Ownef Mail Addresd <br /> City S!aleZp Phone <br /> Tenant Mail Address Ciry State/'Ip Phone <br /> \!��.�1�,-,� ?x ,l'��u Z�nc� ��.a- T�. �n f1 1'y/,(� Y �e cZ.� 1�1'A __ �1Y�(� <br /> Electrical Contractor Mail Addreev � <br /> �IN Slate/ZIP Phone <br /> �,�3 �1�.\� R i q"11 �I b <br /> F.tate Licensr.Number Conlrect Price o!Work <br /> Proposed Usa of Building Contact Person (Plan RevieN�) <br /> Description of Work to Be Done: � :���•�< < �.�� e <br /> NOTE: WIRING IN NON•DWELLINGS IS RE�UIRED TO FEE <br /> 8E IN Fi��CE1NAYS, MC JR ht; CABLE. <br /> 5 S� L <br /> CITY 0�EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certi/y thaf I have read and examined this application and know the same fo be true and ^ <br /> conecL A/l provisions o)/aws and ordinances govermng this type o!work will be complefed / / <br /> whefher speci�ied herem or noL The granfin�ol a permr!does not presume to r�ive aufhonty to � ✓ <br /> v�olate or cancel fhe provlsions ol any other state or local/aw regu/afing constructlon or the <br /> pedormance ol construchon. That I am authonzed by the owner ol this property fo paAorm the <br /> work lor which application is maCe and I comply wrth the State Contractors Law 18.27 RCW and � <br /> 296.20U WAC. <br /> � � "' ___ �� <br /> � / �� <br /> , ,; :, � _ D5 /� �, <br /> . , <br /> S�girature� Date v � <br /> �� � <br />