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"7 /Z(D -0d' Y <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY 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 /> � /U �/'OQ,c��..� �. <br /> PROJECTADDRESS <br /> Owner MailAddress City Stale/Zip Phone <br /> U�� �l�i /lV(v C�/" � �5/G� CYcL' �Cvcy .t`1/-/is-�� ��/ �`��U) Z } �% ��'• � <br /> c� <br /> Tenanl � MailAddress City StatelZip Phone <br /> ����.j �l���'< `13 Z � Z 7 y�' /�.� /ZC ('sr� 'tv �/� c*�✓f �'rS23 z 4�.5 .�7�S�-� <br /> [IectricalCoNractor MailAddress Ciry State2�p Phone <br /> c�J <br /> r.�,z,��i�; ����r' �5U <br /> State Lic nse Number Conlracl Price ot Work <br /> Proposed Use of Building Contacl Person (Pian Review) <br /> Square Footage(if residential new consUuction, remodel or addition) <br /> Descriplion of Work to Be Done: �U�/��c,� e �F'f. N'�C�`/ > �Z'��(GC '�' <br /> 6� s � z����-�t h�� �-��s � <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIREb TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> 5�O <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereUy certify thaf 1 havo�ead and e.ram6�edlhis application and know Ihe same to be true and � 62Cj <br /> corract. All prowsions o(laws and ordmances govemmg fhis type o/�voric will be complefed � ( �1 � ✓ 1 <br /> �rhefher speafied herein ornof. Tho grunfing o/a pennd does not presinne to give aufhonty lu <br /> violafeorcance!!hr �rovisionso(anyofherstateorlocalla�vregu/atingconsfruchonorfhe <br /> peifonnance ol cons�ruclion. That I am aufhorized by the owner oI fhis prope�iy to perfomi the <br /> wo�k�or ivhic i-app!'cation is rnado and 1 cornply�vilh tho State Contraclors Law 18.27 RCW and <br /> 29G.200 WA�: <br /> . <br /> ;� � ��/'i.�--� j�— G� —� <br /> , Signature Dale <br /> % � <br /> ,I <br />