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r <br /> ELECTRIC�►L 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 -DEBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> 5�.,�es .T� N / /�./i <br /> 2�3� ���d�,�� F�P�P,,� w�. �8�d� <br /> PROJECT ADDRESS <br /> ���y �7� t'���e�� <br /> Owne Mail Address Ciry Slate2ip Phone <br /> Tenant MailAddress Ciry State2ip Phone <br /> EleclriCal ConlraCtor Mail Address City Slate/Zip Phone <br /> C`�Y J f �dFiP�� ��/` �5 ��Dv ,od <br /> State Licensu Number Conlract Price of Work <br /> Proposed Use of�uilding Conlacl Person (Plan Review) <br /> Description of Work lo Be Done: �.eM dl�P C��U D D�✓p� IJ Pv�� l °��_ (�l��(r+/P <br /> W � 1/l �12r,/ 20(� �M/' �a4P( �ln� �fBW �Q�PS/� / <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. ���Q <br /> �-- <br /> CITY OF EVERETT LOCAL SALES TAX CO�E IS 3105 <br /> 1 here6y certi/�fhal I have read and examined this application and know fhe same fo be true and <br /> conect All provisions o/laws and ordinances poveming this fype o(work will be complefed <br /> whether speaGed herein or not The granting ol a permif does not presume(o give authonty fo <br /> violate or cancel fhe Provisions o/any ofher state or local law regulating consfruction or fhe <br /> peAormance oI construcfion. That 1 am authonzed by the owner o(th�s property to peAorm Ihe <br /> work lor which applicafion is made and I comply with fhe Sfate Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> �--..r �j`��/�l�nz--.-� `!-(!' p3' <br /> Signature Date <br /> FoSoy-oy 8 <br />