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( <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 I'a =�-��� <br /> 425-257-8810 - FAX425-257-8857 -www.everettwa.org Eo9rz -�43 <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> l / ` <br /> J � -�r�� �jri� IT <br /> PROJECT ADDRESS <br /> `��� j `/ % <br /> ���r' i �1 � �r"i./ f cr(`P�f C-1 � �1�7/� <br /> Gwner Mail Address City Stale.2ip Phone <br /> ,�'�� /'I <br /> Tenanl Mail AAdress Cily_ � � � S�atelZip Phonc <br /> ����,,1�, 4-✓//l 7� �f/ <br /> , ln;.�- l(I �l y��(', r�,C LL � G,:�Cp $T�?.� y `lf�f� '/h 5 :�li'(Y 3'//' <br /> Eleclrical CoNrac�of A1ail Address Cily Slale2ip Phone II <br /> - r LT 4� � j�J <br /> i ,. , 7 ,��1 I � � — <br /> Stale icensr, Number Conlract Price of Work � <br /> , •. -! �(J � L��;.�f �,J� <br /> ;r;.• .. �-� � 5 /i�� rc l ...� <br /> Proposed Usc of Duildinp Cnntacl Person (Plan Review) <br /> Descrip�ion ol Work lo �c Don�: '�Lr C. ��`'S r r��'-t r G � �i�,• «. <br /> NOTE: WIRING IN NON-DWEILINGS IS REDUIRED TO FEE <br /> 4E IN RACEWAYS, MC OR AC CABLE. <br /> i'I I <br />� CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 i <br /> � I harebv��'rtdy fhnf 1 h�ve rcad and cenmined fhis applicnhon nnJ know fhe same fo be fn�e anA <br /> couer,C All prov�sions u�Inws and rrdinnnces qow�rning fh�s fypn ol�voik �rdl be cornplefed <br /> whefhe�specilii�d Imrern or nof Thr I�Idllllli(J OIO�1C/IIIII AJCS IlOI vesurno fo[�ive nufhority to <br /> :rnlafe or wncM fhe provisions ol any ulhe�sfafe or local law�epul<�fing conslrucfion or fhe <br /> penurrnance ol const�ucfion. Thnt 1 am aufho�ized by fhe owner o/this property to pe�form fhe <br /> wo�A lor which applicnfion is made anA 1 cornply wtlh fhe SI<�te ConUacfors Lnw 18 27 RCW and ,% <br /> 29G200 WAC. <br /> , �a� <br /> � � �� � � i ,� ,� � �, � , <br /> .f�„i ' � � .l. � <br /> ��— SignaWre � L a ;� / <br />