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ELECTRI�AL PERMIT APPLICATION <br /> CITY OF EVERETT PERMlT 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 /> ����a���� ,C�'.r���G��� 3z �_� , <br /> PROJECT ADDRESS <br /> ��'�'s ���� �G/GCZ �Tsl�� G✓� �f�o�G c! <br /> OWner Maii Addresc Ciry State/Zip Phone <br /> ;�1 ���,1 f���-7'���—� <br /> Tenanl tdail Address // Cily Slate2ip Phone <br /> v <br /> �����/ ,�cfi;�/LGC , � /��2 �/.� ¢�/. 9��0� <br /> Eledrical Cenlractor —� Mail Address Cily Slate/Zip Phone <br /> �G�G�.L^C '�1�d0� .�CG� � <br /> Stale License Number Conlrecl Puce oi Work <br /> �' � � c��� ��'.'c� <br /> Proposed Use of Building Contact Person �?Ian Review) <br /> l <br /> Descriplion of Wark lo Bo Done: _[ e � l C'rr C !'�.5 � �� �<� C� <br /> NO'fE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACGWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certily thaf 1 have read and examined this application and know the same to be lrue and <br /> cerrect. A/l provisions ollaws and ordinances governing this type o!work�vill be cornplefed <br /> whefher speci(ied herein or noL Th:granfing o/a pemut does not presume to give aufhority fo <br /> violate or cancel fhe Provisions olany other stafe or locallaw regulafing construci�on or fhe <br /> peAortnance o/consirucfion, That I a.ni 2ufhorized by the o�vner olfhrs property to pe�fomi fhe <br /> �vork lor which application!s mado ana 1 comply u�ith fhe Sfafe Contractors Lan� fti27 RCW and <br /> 296.200 WAC. <br /> ���xi-G��y��- ��2z ��G <br /> Signature Date <br /> � c�U�l ' !�/ <br />