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l <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES �d5og _�a� <br /> 3200 CEDAR STREET, EVERETT, WA y8201 <br /> 425-257-8810 - FAX 425-257-8857—www.everettwa.org q _�o_0 5 <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> r��s d���o�3=�� � <br /> PROJECT ADDRESS � � <br /> S/��r✓��/ /N� <br /> Owner � Mail Address Cily Slale/Zip Phone <br /> S�i1✓Z�2�,�cl<S �oFfFF 171 S �(A'�''U'�� <br /> Tenanl Mail Address City Slale2ip Phone <br /> �✓R��"�K� Slcr✓ (c/�P. izf� ��ri�sr� �E.r�� S�e�+c� qFs�d9 �?i6� ?S'2-oT00 <br /> Eleclrical Conlractor Mail Address Ciry SIale2ip � Phone <br /> r/ATrosc �3rM3 _ 2 ��' — <br /> State License Number Con cl Price of WorY, <br /> sr�✓E zqMde/l��n/ <br /> Proposed Use o(Building Contact Person (Plan Review) <br /> Description of Work lo Be Done: � �S I �'1/� 0��" (L lu�niN!}{FD �/✓f}L� 5(CN � �"'�NFljre� <br /> -� <br /> -To s�cN ci�.cu,T ��� �/7hEnS <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby certily fhat I have read and examined Ihis applicafion and know Ihe same fo be We and <br /> correcL All provis ns ollaws and ordinances goveming fhis type ol work will Ge complefed I <br /> whefher spea6e 1 rein or wt The granEng of a permd does nof resume fo give authonly fo <br /> violafe ur cancel h uovisi ms olany ofher sfate a local law reyuPting construction or the <br /> peAormance ol �is�n�ctio . That I am authonzed by the owner of this property to perform Ihe <br /> work lor�vhich a licalion made and I comply�ailh fhe Sfafe Contractors Law 78.27 RCW and <br /> 296.200 WAC. I <br /> y-2o�vs <br /> Signature Date <br /> .��, ��`- i'� � <br />