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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 />4c�9 nl C a�r�-r R.,� . <br />PROJECT ADDRESS <br />q2S -793-�49 i <br />+�—���1�n.e:� �-► D�L C��oT R� Cv�r._ 03 <br />Owner Mail AdArzss City Stale2ip Phone <br />Tenant <br />Afa�i Address <br />W ` 2=-- - <br />[ICClrical Contrector A'a�l Address <br />Slate licnnse Number <br />� C C�'- . C��, � � <br />Proposed Use of Buildin <br />Descriplion ol Work tu Be Done�. �� CT �� G� �" <br />Gly <br />QID9 <br />State�Zip <br />S�ate�Zip <br />Conlrecf Price of NlorF. <br />CoNact Person (Plan Revicw) <br />���2v�c� � IOU <br />�none <br />Pl+One <br />5 <br />-v - <br />NOT[ WIRING IN NON•DWELLINGS IS R[QUII�FD TO FGE <br />HE IN RACEWAYS, MC OR AC CABLE <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 � <br />I he�eby certdy Ihnt I bave read nnAereunineJ Ihis app6ceficn and hno�s fhe same (o be f�ui• nnd <br />corrrcf All provisiens ol laws s�d urduranr,rs 9nvernmg fhis type of �rak �aill Ge complr�trd <br />whethrr spenlied herem or nof Tho g�anf�ng ol a permi( doe� nof vesumo to gicr aufhority lo <br />violate o� cancel fhe provivons o! any ofher sfate er local law �e�u�nhng constiucfion or �hr, r I/n ��9� <br />perlomlance of conshuchon Tliaf I nm aidhon�ed by flra o��ner o/ lhis properiy fo pe�lonn fhe �� L� <br />�ro�k lor which applica6on ec rnaUe and 1 comply �vrth fhe Stafe Conhar.fo�s Law Ip 77 RCW and <br />?9G 200 WAC. <br />K a�"��//��j/ 7�20��� <br />� ' ignature ��G'9L�i/cZ_",CY` • �— -��----- Date —. ..--------- - <br />