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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 / a `a9 `� 9 <br /> 425•257-8810 - FAX 425-257-8657 - www.everettwa.org C D9/2--I S( <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> l / 36 C-t/��T,�, �>` <7'- �. '��T�G.��. ', Z, <br /> PROJECT ADDRESS <br /> C�P,�t i'/"1„�,, <br /> 7`l �r-� `/,�5 �`/`/ <br /> Owner Ma�l AdAress City StalelZip P <br /> �l/� <br /> TenaM 61ai1 Address Clty Sta�Zi{> _� Phone <br /> �r'�,.��., _�� y / dc: <br /> L����AG GJ 7�f/ i�`" /lj,E Y��F S�i�,7 `C �' `�.�5 �l/�� 3 <br /> Eleclrir.al Conlrar,Ior htail 4ddmss Cily SlatelZlp Plwnc <br /> C'�.s Tr l � i�� L T .�� S�'� <br /> Slate License Number Cont act Price of Work <br /> f 5 ��. f ���,- � n � � �/'A l� .j <br /> ropused Use ol Buildinp Conlacl Person (Plan Review� <br /> Descriplion ol Work�o Oe Done: �✓�rL �J �1 j // u! / ' �%�? <br /> NOTE: WIRING IN NON-DWELLINGS IS REDUIRED TO FEE <br /> D[ IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> I hcrrby a�rtAy fh;rt I havc read nnd rx,vnincd fhis applicahnn nnd kno�r fhe snme fo be fruo onA <br /> cormc(. All piowsions ol la�ti:s and rnJin�inc[�s governing fhm lype o!wurk �ti�ill be complefeA <br /> whethnr sperihed hcrcin or nof. Th���rantmg ol n pmrnd Aoes nof/vesume fo qive nutho�ity fo <br /> violafe or cancel fhe�novisions of;�ny ofher slafe nr local lan�re�u afint�construcfion oi fhe <br /> pe�fonnance ol cons�ucfion. Thnf I am nufhorized by fhe awner o!this property fo perfonn fhe <br /> wo�k lor�shich applicafion is n�ad��and I cornply�vifh fhe S(afe Confrnr.Wrs Ln�v 7d.27 RCW nnA <br /> 296.200 LI�AC. <br /> �— ) �] <br /> 7�,C..�' rf � �• +C�^ ` �/'�0��� � <br /> si�nawre �— t U��I Z- I 5� <br />