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� <br /> � ' <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES � �c���b <br /> 3200 CEDAR STREET, EVEP.ETT, WA 98201 ! '�D.,� <br /> 425-257-f3810 - FAX 425-257-8857—www.everettwa.org (� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DE81T 6 CREDIT CARDS ARE NOT ACCEPTED <br /> 3:.�� 3 �ti; << �- . �� � . ���:�, �,�_ . °ra� � <br /> PROJECTADDRESS <br /> �' ��J� , . : t�; �_ti�.. 9azo <br /> �'��"" Phone <br /> Owner Mail AAdresa Ci�y Stele/Zip <br /> ����; � �,� : , , �.. q <br /> Tenant <br /> Mail Address City SlalelLp Phone <br /> J�..� �, c�+� � i5i3 " n� 9z"� �i �� a�-, a �.�.. 9 ��St `Its � I��- 6� <br /> Eleclncal C iractor <br /> Mall Atldress Clly Stale�Zip Phone <br /> <,r ����c-�-�5�1 � � 40�4 s� � 5 5��, ���� <br /> �« < <br /> Slate License Number Contract Pnce of Work <br /> � i� I�J« <br /> Proposed e efiiuAd�u�. Contacl Person (Plan Review) <br /> � i i � ..0 ( � 1 u Y=� 4 �•l� k, fL � . � -N .,._-- <br /> Urscriplion of Work to Be Done �� n ��w -�--- � � <br /> . � .1 � . � n,.��., � � ��. �,�. s�,� . ,;o., �� �...— �. � � <br /> v � ,�' � A, ,,., r�� �� IJini I� � <br /> —�.s <br /> NOTE WIRING IN NON-DWELLINGS IS REOUIRED TO FEE <br /> BE IN RACEVVAYS, MC OR AC CABLE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3106 � � ? <br /> : <br /> 1 hr,reby cu�trly fhof 1 hnvo�oad and axanrined fhis app6cahon and kno�v the sarno fo be true and � L�L� - L �� - <br /> correcf All prov�srons ol laws nnd o�dmnnces governmg fhis type o/work wdl be cornploted <br /> �vhefher spenGed herem or nof The 9ranhn9 0/a pomuf does not presurne fo give�uthunty fo <br /> wola(e o�cancel fhe prows�ons ol any other sfatu or local law regulatmg conshucfion or fho <br /> pe�larrrance ol consfruchon Thaf 1 am aufhonloAby the owrw o(fhis properly to perlonn the <br /> work lor wluch app6calion a nrado and I comply wdh fhe S(afo Confracfors Lm+� 18 21 RCW and <br /> 296 200 WAC. <br /> _,� � 1 <br /> l � <br /> Signalme Dale <br />