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� � <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT S�RVICES <br /> I 3200 CEDAR STREET, EVERETT, WA 98201 � � '-' � g��7 <br /> 42�-257-8810 - FAX 425-257-8857 - www.everettwa.org � p �i 2 -/Dy <br /> / <br /> APPLICATIONS ARE ACCEPTED FROM J AM TO 4 PM <br /> � / <br /> `����� (.r� �at;iA/v �1� , _ <br /> PROJECT ADDRE:SS <br /> � ' <br /> I �- � <br /> I ➢ i <br /> ����t� ip1t.'�/ -- C �ar.l � I � ( / � <br /> Owncr A1ail A dress Ci State2ip Phone <br /> TonaN �9ail�ddress City Stale/Zip Phone <br /> Gl�✓C• - S//�l= /'/�r /rt ,t /,��C . /�G�2u/: �,�l�i 1�d172 xBcrS-�i6'S <br /> Eleclrical Contractor hlail Address City SlaleQip Phone <br /> I � /7 � ,�. <br /> L //�E-sc=i dzln�cc �.;. �, ; � Y 75� <br /> Slete Licenso Number � �' Contracl Price of Work <br /> Proposed Use ol 13uilrlin9 Contacl Person (Plan Feview) <br /> Description ol Work to �c Dan�: ��/� j�� � �-�"��i�. � /�L�� '�F`f'�"�- %"'L. /9r�7 /� <br /> � <br /> I '�,�z� :cS c'� i S s �:w. Cr YS r.1 � <br /> NOTE WIRING IN IJON-DWELLINGS IS REOUIRED TO FEE <br /> B[ IN RACEWAYS, MC OR AC CABLE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby r,aidp fhuf 1 hnvc��onAnnd ex�mined this apql�cniron eno know fhe same lo be Irue nnd <br /> coner,L All prnvisinns o!Inws and oiAinances r��vernrnq fhis typn o!�tivrk will be,contplefed <br /> whelhe� speci6eAherem or nol. 1'he granfing ol a parnul Aoes not presunm fo giva aufhority to <br /> violafe or cancel fhe pruvisions o!eny ofhei sfafe ur;ocal law repulafin,q construcfion or fhe <br /> peAormance o/consl�u:lion. Thef I arn authnrized by fho owner o!f.his property fo peAorrn fhe <br /> worh Inr which applicahon is maAe and 1 complp�tiith tAe Sfate Controcfors Law 78.2!RCW anA <br /> 29G 200 WAC. <br /> '� .:�— . --`—_..... . _.._._ <br /> / z �6' a7 <br /> - --'�"--—-- Date <br /> Siyn;ilure <br /> '�: L1� Z' � �/�I <br />