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ELECTRICAL PEP.MIT APPLICAT'ION <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 - DEBIT 8 CREDIT CARDS ARC NOT ACCEPTED <br /> 130 S G?�/-C 30 <br /> ---�n 2;lrz I�)�`��" ��i41� � <br /> PROJECT ADDRESS <br /> OWner Mail AdAress Ciy --Slale/Zip Pl�one <br /> �j�' /r �� I �5'r 11��;; �I <br /> -1.,Ci��rte� PIe�tT I,U�1. — <br /> Tenant �fail Address City Slate/Z�� Phono <br /> (3too� <br /> tb st Lv�! 48zz3 L3'9.'�3�0 <br /> l� �lec�,r ic '�+L�-. 3Sl�� I lo� PL nl F lo� ��_ ����� <br /> E�eclrical Coniraclor �1;iil AdAress Cny Slate/Zip Phone <br /> S�I��l .C. � -�f- Cil1� 1� �n � �v bD — <br /> Slate License Numbor Conl�rico ol Work <br /> �Il�in� J�/�� � �� Ct��"tYl <br /> Proposed Use o�Building Conlacl Person �Plan Reviow) <br /> Description of\Nork to�a Done: I � � � <br /> S,� �,� d��n s :, rs - <br /> tJOTE: W IRING IN NON-DW ELLINGS IS REUUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. ,��a� sO <br /> O <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 he�eby cerTily fhaf 1 hav�renA and eraminrd Ihis applicafion and kr,ow Ihe same fo 6o frue and <br /> conr.cL All provisions o/laws and orAinances c�overnine�ffris type ol work will be cornplefed <br /> whefher specdied herein o�not The g�anfing o/n pemut dcrs nof veswne,fo give aulhority fn <br /> violafe or cancel fhe provisior,s o/nny other sfafe or local Inw mgu�ahng consfrur,fion or�he <br /> pedormance of conslnicfion. Thaf I am aidho�ized by the owner o/lhis proPerty fo peilorm Iho <br /> work Ior whir,h applicafion is rnade nnA I comply wifh fhe Stafe Confrnctors Law 18.27 RCW and <br /> 296.200 WAC. <br /> �- / <br /> � /Si9nature �/ �2�— S/a�� <br /> �� <br /> � _ — €� sa.� � �( � <br />