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ELECTRICAL PERi��IIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 y� a3_O� <br /> 425-257-8810 - FAX 425-257-8857-www.everettwa.org �O�0 '�!-� 3�O <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> 3C�03 l.J C.a�s�nu 2c\ '��IS - �:�',� ��c.e1}, wA �1� 1-►.3 <br /> PROJECT ADDRESS <br /> (Absl�,. c�nsl.� c-�,o�> ��s3 ) <br /> �c'_�na �o. 1�� �Ioy. Z8U Q�yc.�.Qu,-P wA `i�37/ '_l46-3`/b� <br /> b <br /> OWnBr��' MailAddross Cily SWIe/Z.ip Phone <br /> 3vo3 W Casit�o Q.ci <br /> �oeiv�c�- S�QQ-f �.�cw Eve.�e�' t-'✓� Q� 113 N/A <br /> , <br /> Tonenl Mall Addrass Cily SIa1M2ip Phone <br /> Ca��) <br /> Y�o.c�0 nA�t� ✓�h���Ju/ �171"1 �t'f r o f�- f;v�� S W S[ca� W 11 qk/Ole �d�•y�7 B <br /> i <br /> ElCdrical Conlractor Mai�Addross City Stalc/Zip Phone <br /> �/1�qC _7on�r- 9�a i� F �/Wc�9 � ��� `�( <br /> Stale License Number Conlract Prico of Work �y 2S� <br /> C uw�+..+,r� c c� <br /> �1o.,rk kl. � a �t�b�57o <br /> Proposed U^e of Buildinq Contact Person (Plan eviow) <br /> Doscription ol Work lo Be Donc: Glq CT ' �v W ✓ U ��Aqp 7 —S'I-A"r �^/�b. 0T7�� <br /> �'1'�IGC � � VJ�"I�.r.f� C..Or�firo�s• <br /> NOTE: WIRING IN NON-DWELLINGS IS RE�UIRED TO FEE <br /> �E IN RACEWAYS, MC OR AC CADLE. <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 5105 <br /> 1 heroby cortily IhUf I have road nnd exnmined fhis npplicaGon end know fhr,same to be frue and <br /> correct All provis�ons o(lews and ordmancos govommg thrs typa ol work will be aomplefed <br /> whefher specrlied Irerain or nol. The�rannn9 0l a pemul doos nof presumo fo give euthority fo <br /> violafo or cancol fhe provisiuns ol nny other stefn or locnl law regu/nfing consfnicfron or fho <br /> perforrnanco o!conshucfiorr. Thaf I ern nufhorizod by Bre owner oI(his proporty fo peAorm fhe <br /> work lor which nppOcafion is madc nnA I comply wifh fhc Stafo Confracfors Law 19.27 RCW nnA <br /> ?9&700 W�C, <br /> �\�� o.-�.�_. ��Y 9 - 2_3- o� -- <br /> .,i<�e �A 2l(1 ��O LL Datc <br /> �U��`I- � ' � <br />