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�� <br /> ----- -� - -- - ---- -- <br /> ELECTRICAL PERMlT APPLICATION <br /> CITY OF EVERETT PERM{T SERVICES <br /> 3200 CEDAR STREET, EV[RETT, WA 98201 <br /> 425257-8810 - FAX 425-257-8857-vwvw.everettwa.org /�y3 �2 <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> > i S C� 5 T CWSi� c 12 !� <br /> PROJECT ADORESS f/,rl�� <br /> . � 7✓0-lis`� <br /> Gr/��.�1� E�C /�rE.�_ � �7/G�+ Ev'�K_cn�t�e,u' ,,�:� �✓�.dtrTi�wa`7�'�O <br /> Owner MadAdOmss Gy S�ale2D Phone <br /> �3c�05 % P�L�'��CfL 3% 1 GAS 1 CAS/�JD /z./� EV�ICE.TI.[c� Y�YzoK <br /> � <br /> ienant Mad�Atlmss C�ry StateR�p Phone <br /> U1� <br /> �G�� S�tT�H. S �/o�i /3y �., �,crt ,�i,�c �,��� ,,�v 9� aa 3i3�3 <br /> flBCtncalConlracl0r MaAAddress Gly Slale2�p Phone <br /> �CU�Si d G[� ��Z �/�O • d^' <br /> State License Number Contracl Price ol Work <br /> Pmposed Use o1 Bwlding Contact Verson (�'!?n Re�ew) <br /> Square Foolage(If resiAent�al new construction, remodel or addihon) <br /> Oescriphon ol Work�o Be Done �'��1 .0 F L L �: 7 E� S <br /> NOTE WIRING IN NON-DWELLINGS IS R[QUIRED TO FEE �� \ <br /> HE IN RACEWAYS. MC OR AG CABL[. � () <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> I hereby cert�ty fbat I bave reaA anA r.xamined fhrs app6cahon and hnow fhe same lo be We and � I � _ O�� <br /> r.o�rar.t All provisions o/laws and orA�nanr.es govemrng Ihis lype o/work wdl Ae romplefr.d �l <br /> whethr,�spr,cilred hemm or nol The granlrng of a permrl doos nof resume fo grve authonty fo <br /> violate or cancel tho proasiorrs ol any ofher slate or local l�w ruyuPf�ng conshucfion or Ibe <br /> perlormance o/r.onsfrochon Thaf I am aufhonred by fhe owner ol fhrs propeAy lo porfo�m!ho <br /> work!rn which applicahon is made and 1 compty wdb fhr. Sfale ConVacfors Law iB 17 RCW and <br /> 296 200 WAC � <br /> � //— �� -- / Z� <br /> Siqn. ne � Odle <br />