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i — <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, F.VERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www.evereltwa.org <br /> APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM i ' � � <br /> �� Z-"l � (��t6VU0 �� �Vz2.e:TT ��I ,�c, �,% <", <br /> PROJECT ADDRESS <br /> � <br /> �;� �;, U.C�� �� ����;AvG S �� wia `��o'��c ��ys4 <br /> Owner htail AAdress City SlateiZip Phone <br /> TenaN Mall Addmss Cily Stal�2ip Phone <br /> �L� � �, <br /> ��l-I-i}i,n„ w ��t�Ojt 1 �r �l �' _4Z ,�-n��t.. .`�W lil]eX�11 �Lu �JA lbD�� '1j� �llSil) <br /> E-loclrical Conlractor A1ail�dAress Ciry S�ale2ip Phone <br /> �TT lTG I '�"14 �C, . � //, '�lr� _ <br /> State Licensc Number Con�racl Price o1 Work <br /> /�U�Z�AaA�i .�.��L��NL G�, � �n t;.�C+�Ji��Z <br /> ProposcA Use of Buildin� Cnnlacl Person (Plan Review) <br /> Description ol Work to Bc Donc: �� _P.k� �i�e�_;,P��3�p� ��,�tir. �� �Pi�.an��_,ti ____ <br /> NOTE: WIRING IN NUN-DW[LLINGS IS REQUIRED TJ FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITV OF EVERETT LOCAL SALEu TAX CODE IS J105 <br /> I haeby certil}�fhat 1 have reaAanAexnmined fh+s npplicnfion end know fhe sarne to be fruo nnA <br /> correcf. All provisions ol laws end oidinonces�overninq Rus typo ol work will be complefed <br /> whefber speciliad herein or noL The yrnnfing of a permd does nof resurne to givo nufbonry to <br /> vrolnte o�cnnr,el the I�rovisions ul ony afhe�slate or:ocel law mpuPting construction or the <br /> perlormance o/%onsl/UCGO/l. TIIt1I I FIIII Afl(IIOfIZBA�J}'�IIB ON'I1CI OIOIIS�)I0�)PI}}'IO nB(I0Il)7 II70 / <br /> work lor which applicnfion is rnade ai�I comply witl�fhe Stnt� Confrocfers Law 18.27 RCW end L <br /> 29G200 WAC. � ��,J <br /> .. ------ ��/� "/ �I�. <br /> /'` / � <br /> io�`_t--��J / i �' . /`. �i�7 <br /> i � <br /> Signawre / Date <br />