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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-881� - FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT �.ARDS ARE NOT ACCEPTED <br /> 21015 L.). �45iNo�oaD _ <br /> PROJECT ADDRESS <br /> TM I�1 �CoeM�c►C 210�5 �.1. C'a���Nc� 12.a vE�-�-r 9 s2o9� <br /> Owner MailAdtlress Clly StatelZiO Phone <br /> % <br /> � L � �'�L' ' .J� L � <br /> TenBnl � Mail Aatlress Cily StaleiZip Phone <br /> �„r,E �F�rEic i��i S� Z'"' �r [��u.E.vUE 98cnS 42s 747-62oG <br /> IEIeN,ncal Contractor Mad nCdress Cl�y State2�p Pnone <br /> • �ZIMfeF_= I.�$ � � �i�OQ •�� <br /> Slate Licrnse Number Contract Prico of Work <br /> Proposed Use of Bwlding Conlact Person (Plan Revlew) <br /> Descnption ol Work to Be�one: I�Ei�J G�1-5 �OQ. �?1JE(Z Qd�BTZ.R F�►�OSp(. Q�WASNf.Q <br /> QRrnr�TE Z— L�c—�lT F�KtiJ c$ ToTA - N �.� C'JfTS ��S <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRE� TO FEE <br /> 9E IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> I hereby cemty fhaf I have read and examined this<�oolicafion and know the same fo be frue and <br /> ccrrecL All provrs�ons ollaws and ordinancas,ova, .mg fhis type ol work wdl be completed <br /> whathe�speu�ed herein or noL The granung ul a fermd tloos nof resume to grve aufhonry to <br /> v�o�are or cancel tne provisions ol any ot�er state .�r,ocai law�eguP��ng construction or the <br /> per!ermance ol cons(ructiort 7hat 1 am author�ed Oy the owner ol fhis prvperty to peAorm the <br /> work 7or w cn ap IicaOon rs metle anC 1 comr:;�wRb fhe Sfare Confracrors Law 78.27 RCW and <br /> • 296.200 C. <br /> / /�i II <br /> ��� l��la�— <br /> S�gna Date <br /> � l�`>�/ �/t%� <br />