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i�� <br /> 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 /> �W J � l�./V��� 4—� <br /> PROJECT ADDRESS <br /> ����_��:�k�l���v � - � � <br /> er MaiIACEress Ciry Stale/Lip Phono <br /> �`� �� '�CP <br /> enan� MailAGtlress City State2ip Phone � <br /> lm(l �`( C�1 ��1�1�����`�Q,��=� vl� �� �� ' <br /> Flectrica Contractor MailAEdress Ci1y Stata2ip� Phone <br /> �Y' `�XR�,�YY'11`� _ �����— <br /> Slate License Number Con rect Pnce of Work <br /> ('(lmrno���� ��"���.II (��lU�l <br /> Propose�Use of uilding „�pptact Pe�n (PJa=Review) �� <br /> Ls`�� - "" �-�o G�' <br /> Desaip6on of Work to Be Done: ��'Y� l�l C �`�J -�Y �C ��`l <br /> NOTE: WIRING IIJ NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY Of EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hero6y certdy fhal l have road and ea�amined this app6caGon and know tbe same to be frue ard <br /> correcl All p�nvrc,�ons o!laws and ortimances govemmg fhrs type ol work wiG be completed <br /> whether speci6ed hemm or noL Tho gnnfing ol a pormR does not prnsumo to give aufhonty fo <br /> violafoorcaneolfho pmvisionsolanyothorsfafeorlocallawregulafmgconsWcfionorthe <br /> porlortriancro o(crnsf�uc6on Thaf 1 am aufhonzed by Ihe oH�ne�ol fhis pr�perty fo peAorm fhe <br /> worklor which applrcat�on is matle and 1 comply wdh fho Sfate Confractors Law 1B 27 RCW arri <br /> 296 200 WAC. <br /> �� <br /> � "� .� �-'�, �� � I � — <br /> �__ <br /> SignaWre Date <br /> 1-=��d�V 7Z <br />