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l <br /> ELECTRICAL PERMIT AP�LICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 S/�j�i 2 <br /> 425-257-8810 - FAX425-257-8857—www.everettwa.org ���,OS-0'ZZ <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> O 1 � - - �'�c'�/ <br /> PROJECT ADDRESS � <br /> Ovmer Matl Address City State2lp Phone <br /> Tenanl Mail Address City SlatelZip Phone <br /> /� %i��r%%,� �G/-�T/l�'�' �S-/��'r��s �.�/�/39r.�v� St'�tJ�,� � <br /> Eleclrical ConVactor Mail Address City State2ip Phone <br /> itir�,.�r�s ,Y�r�.�5 �y0o <br /> Slale License Num er Contract Price of Wark <br /> Proposed Use of Building Contact Person (Plan Review) <br /> DescripUon of Work to Ba Done: /��,/,7%jl.(� J,�QA•Ur/�/l7pe�.! ��Gr/T/JO/1� <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. �� Q J <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 � l ZO 5 —O Z� <br /> I hereby cerfi(y tliat 1 have read and examined this applicntlon and know the same to 6e true and <br /> correct. All provfs7ons o(laws and ordinances goveming thls type of work wifl bo complefed <br /> whether specified herein or nof. The granfing o/a penmt does not presume fo gfve authonty fo <br /> viola(e or cancel the provis7ons olany other sfate or local law reguleNn�construction or the <br /> peAomianco o/constrvction. Thaf 1 am authonzed by the oimer o/this propedy fo pedorm Ihe <br /> - --work-7or-which eppllcafiorris mede and bcomply wifh fha-Sfefe 6ontrec(orstew�?8:2TRG4V�end <br /> 296.200 WAC. <br /> ��• //�J /�� (id/id-.1Y I/y/.Jzr�/�C <br /> �Signature Date <br />