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ELECTRICAL PERMIT APPLICAT(ON <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 -www.everettwa.org ��� � y� b 5 <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �(j 9/�-/(�3 <br /> , ,qp <br /> ..Z.� �_, Lru�L< i � ; � i �- � {�. ✓�c�, i��� �^f ;::w-- Nvtn.��ao�� �-}!� <br /> PROJECT ADDRESS <br /> . - -� ' <br /> '� `.�c'._t. �'l.:.. <br /> Ownor Mail Address City Slale/Zip Phone <br /> Ten3n1 Mail Addross City StalelZlp Phone <br /> . <br /> -4-��:.1+�.!"��r � `=i' "�' �'��� � � �I /1�1 � �.�,�.v; l�� �,�-! ��Z %c, ,c:��� c s�s �a! <br /> FYIOG�f�:�IConUaC�ot MallAddress Clly �Iale�Zlp Phone <br /> S��� �l ! 1-C � �� " i', � ' .���_. l� Cif27L� — <br /> Llcensa Number Contract Price of Wor6. <br /> 1" ��� l i ���=�. � ��,�.� 1�+�-���� <br /> Proposed Use ot BWldinc� Conlacl Person (Plan Review) <br /> r ,' , <br /> Descriplinn of Work�o Oo Don�: �C.};;�.�_ 4 ���_1i L�; � � 1 - i�. : i4�.'r . .'� f'Yt�. � }`f\i N. �-- <br /> f <br /> NOT[ WIRING IN NON-DW[LLINGS IS REOUIRED TO F[E <br /> D[ IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS ]105 <br /> 1 hereGy certily th�l I nave rend and exnmineA fhis applicn6pn anA know fho seme to bo fruo anA <br /> carrecf. All provisions ollaws nnd e�dinnnces goveniin,q this t}�pe o/H-ork will Ge complafed <br /> whe0�er spnci6ed herein or noL The grnnting ol t+porrnit Aoes nol presurne fo gi�e e�fhonty to <br /> violafe or cancel the provisions o!ony ofher s�ate or lucnl lew repu/afinc�conswction or the <br /> perlominnce o/consfruction. Thaf 1 nrn eufhorized by fhe o:enor o!fhis property fo pedom�fhe <br /> work lor which epplicn6on is mndo nnd I cornply u�ith the Sfate Contrncfors Law 18.27 RCW end <br /> 296.200 WAC. <br /> < <br /> ! <br /> �. -._/ �-�� � � � �� ll �"S�/�1 <br /> , �S�gnature � • ale <br /> � � � �� �3 <br />