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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> 1++_ 3cr_���G Cc�w�V�7 <br /> �co3 �,� . �w��.�c 2o�v, B�..116 4o -Sy- <br /> PROJECT ADDRESS <br /> H� �„+� �NPY1�.lY Po Sor 3�0� MJIF64 �+�.�'t� IAR "�15121}. <br /> Owner Mail Address <br /> Ciry Slate2lp Phone <br /> Tenant MeA Adtlress <br /> CiIY StateRlP P�one <br /> CNArrPtow a Pdxc. wr_ IC�� IS'�s,— :u �Ab6�erv "•�1 `-i50o� ZJ� '�� ' i S� <br /> Electnral Conlractor Mad AAdress City Slate2ip Phone <br /> LH-YlH�Pf4i-u���- ��L � �O g� � <br /> State License Number CoNract Price of Work <br /> Q�-06 �f.p�.��Z � �?-a-f -�G 2.'' <br /> Proposed Use of Bwiding Comact Person fPlan Review) <br /> Dascnp�ion ia Woik t��Lic Uocc �ro�u�T_� W Wlfa rYsp_ �(LIDC� C{jygu' (�i <br /> —. __ _-.___ _ . .____--..__.__-_____.—_—._ <br /> � <br /> NOTE. WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE � 2D2�� <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hweby r.eRJy(h,�f I have m;id nnd oearn�nod tlns�ppLc�Lon anJ knuw Iha sanrr�!o be true and <br /> cnrrect All prowsrons o(laws nnd o�7inanr.os yovr,mmy fh�s lype o/�rork will be cornple!ed <br /> u�ho(hr.r specrfied herem or noL 7ho granLng ol a ponnd does no(piesurne to�ive aufhority(o <br /> violale or cancol fhe prowsiau ol any ofhor sta(e or local la�v reyulafing consfniction or the <br /> porlonnance o/cons(iuc(ion. Tlruf/am aufhonzed by fho o�vncr o/this proporty to pedonn Ilro <br /> woik lor�vhrch applrcahon is madc and l cornpty tivith fho Stafe Conhacfors Law 1827 RCW and � <br /> 296200 WAC. <br /> �_ . �, �t - . � li _ . <br /> I �' <br /> SignaWre Datc <br />