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i <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> A25-257-8810 - FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> oW 2O D(Uac.lwuy <br /> PROJECTADDRESS <br /> 4�0� C�c-�vti �21 (�i•7 � Cu�eStc��s l../(-� �825� �f2SS 33Y�133 <br /> Owner MailAtldress City Stale/Zip Phone <br /> C�-eur�� 2G2o �r«,�G.,�,� �ves� c,,��-- 3�-Y��-�3 <br /> Tenant Mail Address City Slate2ip PM1one <br /> �c -�f's� „� 2Goe Nw �`� S�,rf� (�.J�U-�lK�� lrl-�- �8275 ��G-�29-�3? <br /> ElectricalContract0 MailAddress City StalelZip Phone <br /> �1�,,�-e�sc��2c� 3�� <br /> � <br /> State License Number Contracl Price of Work <br /> �,�c�.S s��.�,.,� atU ���4 3Gv-y2Y-�3zs <br /> Proposed Use of Building Contact Person (Plan Review) <br /> Description oi Work to Be Done: ��S/ � e4.��ra� JC��..4CJ�� <br /> / �— n <br /> � Aile 5���'l �-�4HU��d�s `I'$,cJ4�tti-lT5 4�ue N`H�� <br /> � - �..,�a.�,( $c- <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 5105 <br /> f hereby certily that I have read and examined this applicafion and know the same to be true and <br /> correcL All prov�sions ol/aws and ordinances govemmg this type ol work will be completed <br /> whetAer speaGed herein or noL 7he granfing o(a pennd does notp resumo to givo a�dharity to <br /> violafe or cancel the provisions ol any other state or loca/law regu/ating construction or the <br /> pedormance o(construchon. That I am au(honzed by the owner o/this propeRy to peAorm the <br /> work lor which appfication is made and 1 comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> ��P � ��(s- s- <br /> 0 <br /> SignaWre Date <br /> �GS II ,oq� <br />