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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, Eb'ERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 -www.everettwa.org � a ��� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM C091 Z�-1`� � <br /> �( '� �i ch��7;-r� r� <T �r/�7P �r.� <br /> PROJECT ADDRESS <br /> �P,, /1���� o ��r�-71- oc i� `/•�5 �`�y ` 7-� <br /> Owner M1fail Addmss City Slale/Zip Phone <br /> Tnn;inl MiiIAAAr�ss �/�� �,�7-H ��-�� Slalel2ip Phone <br /> ��ST ri;�rr N /�l�'iT�� �-,�/C� si<<r,��� . a!� 9�,�5� �/.>.S otli,� �7.� <br /> Eleclrical CoNraclor btail Aed�ess Cdy SlalerZip Phone <br /> � . .� 7;Y/ � 3� L T /�,S ��� <br /> S�le .i rnse Number Conlract Price o1lNork <br /> /��� l� rrt ,� /l _IJ�_.:-r. Fi��, �cl,>> <br /> Proposed Use ol E3uilAing Contact Penon (Plan Revicw) <br /> Description oI Work ta 0�Dono� tiC'�i C ,�.1 j���f��0� / <br /> NOT[: WIRING IN NON-DWELLINGS IS REOUIRED TO FEE <br /> EiE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> I hemby cerLly Ihnt I hav��rend and cxmnined fhis applicahon and know fhe snrne fo be hue anA <br /> conec( All provisiuns o!L�ws nnA o�d�nnna�s yovernuig fhis f}'pe ol work tvdl be completed <br /> �vhrthi�r specihod hcrrm or nof. The�ranhng o!n prnnd Aocs nof presurne fo give nufhority to <br /> ��iolafi�or cnncrl fhe �rowsions ol an}�ofha sL'�fe or local lnw ro�ul�hn�r,onsfrucfion oi fhe <br /> pmlomiance o!cons�ruction. Thnt 1 am aufliori:ed b}�fhe owner ol fhis property lo perlorm fhe <br /> worh lur which npplicefion is rnaAe and 1 comply wifh fhe Sfafe Contrnclors Low 18.27 RCW onA <br /> 291i.200 WAC. <br /> jt��<< „�r'l �./�-�-,�,,�' �� �- o . �� _ i� 9 <br /> SignaWre �� � <br />