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1 <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMI�' SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857-www.evereltwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> 3��-G a�e�xv� , 5ui�io► <br /> PROJECTADDRESS <br /> _'►�ST 6An��.�nti C����a2,. u.� 2'lt� �otic�a�_.�,e_Av� Lvl�nrr;kJA- 9$to) <br /> Owne� MailAddress Ciry Stale2ip Phone <br /> �Sl'�ht�t'�1'lvbL1G.S llllo ✓IlQlnl►.11Ar4*' ��^,l�l'i_� . ��J � �� �1 <br /> Tenanl �dail Address Cily Slale2ip Phone <br /> 65$A- .5�u ,e►.��A�N�,�� £s�i9�S�herE � r�.tb - ,n2 R��Jo2 5Y�'�5'S9� <br /> Electrical Contrador Mail Address Cily Sta1e/Zip Phone <br /> �SS���'�'i'��1�fll.-0 �j'�j— <br /> State License Number Contracl Price of Work <br /> �J�l�il�'1/ �JL��� l.M�i �u�lL-K�rLt� <br /> Proposed Use of Building Conlacl Person (Plan Review)��,YaS•S� <br /> Descriphon of Work to Be Done: I NST)�'j��• �(��lV��IJI+-�'�'�(� ,(,Jkj,L�s] ' �� Mp� ��, <br /> NOTE: WIRING iN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC Ok AC CABLE. <br /> C�TY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certily that 1 have read and exarnined fhis applicafion and know tho samo to bo true and / , ( 5. <br /> correct. All provisions o/laws and ordinances govemmg Ihis type ol work will be comp/efed 1 i I��j � <br /> whefher specrfied herein or noL The granfing oI a permd does not presume to give authonty lo (� <br /> violate or canc�/the��ovisions ol any ofher sfate or local law regulating construcfion or fhe <br /> pedormance ol wns,ruclion. That!am aulhorized by 1ne owner o/this property to pedortn the <br /> work lor which application is made and I comply with fhe Stale Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> - �`cv�- 3�aq/ao�o <br /> SynaW e Date <br />