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� � <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT P@RMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8057—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM <br /> Up �I3 J a �r� �✓o,��c� <br /> 3p a 3 �1�5} ��i5�'� o �r� v f. /3oc�h �. �-��'T ( a�acW� - oSS � <br /> PROJECT ADDRESS <br /> t� <br /> �YIo�C��� �v;ld� ti5 SySf�''�S pa��/�%Z L.�� g8o �17 <br /> Ovme� Ma�l Addreee Clty Slete/Lp Phone <br /> 13 D � �`►-zX- <br /> Tenent Mall Addreae Clty Slete/Zip f'haro <br /> Kcjl � cl�c ��' c �0 13vx 1'2L �°ut , /'�z U�i q8o '� � <br /> EleGrlcel ConUedor Mell Addresa Clly State/Lp Phona <br /> Kcll `/E �- a17NF .� S-4dt� .� <br /> State License Number Contract Price ot Work <br /> T�,,,� ���o��� 1 � � I �� . � � <br /> Propoae�al8uiiding Conlect Person (Plan Review) <br /> Description ot Work to Be Done: � ��S }a II � 2> 3 �� �'S� �JWI� G ` � <br /> 3- 2 � � C7V � � � S <br /> NOTE: WIRING IN NON-DWELLINGS IS RE�UIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> I C�TY OF EVERETT LOCAL SALES TA%CODE IS 3106 <br /> 1 hereby certlly thaf 1 heve read end examined fhls eppllceNon end know fhe same fo be frue end ��� .(��-`� <br /> correcf. All provlslons ollaws end ordlnences govemin9 fltls fype ol woric wlll be complefed <br /> whethar specl/!ed hereln or not. fie granting ol e perm7f does nof presume fo plve eufhoNty fo <br /> Nolafe or cance!Ihe provlsfons ol eny oU�er state or local law regulating canshucflon or the <br /> per/ormance o/constructlon. Thaf 1 am eufitorized by fhe owner o/fhls property fo pe�fam fhe <br /> work/or wh7ch appllcaflon Is made and 1 cornply wlfh fhe Stete Confracfors Law 18.27 RCW and <br /> 286.200WAC.� 1 <br /> �i� � � <br /> Sipnalure e <br />