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( <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 /> � "7 ��.Z L_�r�4 �c��i �/ <br /> PROJECT ADDRESS <br /> 'S�GcK� ��//-/�_ Ji-J�� �!G 4•��ci-</G�i/PtVJ! C.a,t" ��"N- Z� �1� �J� <br /> OWne� Mali Address City State2lp Phone <br /> -�-�-G�E�v.0 ' ' /�r��,�;�c �c-�-SL— <br /> Tenanl Mail Addres City SlateZp Phone <br /> L�57 �'/<<�v�� ��1� 73 ff.S� ��.pr1 c.,vt- Y�' .5srs3y) <br /> Eledrical Contrector Mall Address Ciry StalelZlp Phone <br /> 1�d 5"L �- �-O�Z.Z t� Z- i ��v� <br /> Slale License Number Contrac(Price oi Work <br /> ��`S�"�t''� Contaci Person (Plan Review) <br /> Proposed Use of Building <br /> Descriplion ef Work lo Bo Done: �/z-��� li[r/C�� � �� ���/s-r <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 � (�p O,�- O��j <br /> 1 hereby certily thaf 1 have read and exanlned}his applicafion and know the same to be frue and <br /> correcf. All provlslons ollaws ano ordinances goveming this type o(work will be completed <br /> whefher specified herein or noL The granting ol a�ertnR does no(p resume fo glve authonty fo <br /> violateorcancelthe provisionso/aayotherstateor/oca/lawreguletingconsWctionorfhe <br /> perforrranco o/constructlon. That 1 am aufhonzed by Ihe ownero/fhis property to pedorm fhe <br /> Hrrk(or which appllcation Is mado and/compty wilh Phe Sfate Confracfors Law 18.27 RCW and <br /> 296.200 WAC. <br /> `�"—�:,/ �]12.��-` -- �r—�L�i�---� <br /> Signa ! Date <br />