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— � i <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT �ERVICES ( <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 -DEBIT 3 CREDIT CARDS ARH NOT ACCEPTED I <br /> i <br /> � f5 F1.S+ Ca��ro � �^��� � I <br /> PROJECT ADORESS � <br /> ^ �-�'?(e ,,,b�l le..d f�rk � <br /> �t1�Or (1�•+S�" ScfJ'.IlS ^"c IJ• '�a*�La W/j �/03 �o(c� j <br /> Ownef Mall Addresa Clry State/Lp Phone <br /> �� ! .�E nl ��caS 315 E �nsrne �d �n�'t� �ucrttf. �� o'�oG tc�7 <br /> Tenant Mall Addresa Clry Slate/Zip P�one <br /> �i� �� �-��,� ��. ;'o,�x aii� �.��n��� , ,� �3c� ��s�� <br /> Elecldcal Contractor Mall Addrese Clty SlateRip Phone <br /> �IG EC.� Y-t S��k K � ���� <br /> Stale License Number ConVact Price of'Nork <br /> -�,-�,,.�5� J���.�.-.�� ,� � �L.-.� �. --��� i <br /> Proposed Use of Building Cantacl Person (Plan Re•�lew) <br /> DescriptionofWorktaBeDone: �� �'"�r� �2�+��' �Or'`'i �-.� <br /> NOTE: WIRING IN NON-DW ELLINGS IS RE�UIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby certi/y that I have read and examined fhls applicatlon and know the same to be true end <br /> conecf. All provisions ol laws end ordinances governmg fhis fype ol work will be complefed <br /> whe�her speci�ed herein or not The granting ol e permR does not resume to give authonry fo <br /> v�olate or cancel tha provisions ol eny other stefe or local law reguPfing consNucfion or fhe <br /> perlormance o/construction. That 1 am authanzed by fhe owner o/tbis property to peAortn the <br /> work lor which applicallon is made and I comply wifh the Stafe Contrecrors Law 18.27 RCW end <br /> 296.20 WhC. <br /> ��l' � �b � 7� /� / <br /> Signature Date <br /> .� � a��� <br />