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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 425-257-6857 — www.everettwa.org � — �3—�� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM C�D`�'�� <br /> �9�N�i 3�� w��i C�S��� ,� � // �'�� �/s"sr3 <br /> P O�DDRESS � <br /> Owner Atail Address Gty Slale/Zip Phone <br /> TenBN ht:i,l AdAie.^.s ��� QI7 State2ip Phone <br /> f����_ �o���L— ��Vlccf_�����-�� <br /> ElectriCal Con�raclur LIdJ Addiu�.> t:n, StalP'Lp Phonc <br /> � ��� <br /> Slale I_ir.ens�Numbr.r Conlract Price of WorY. <br /> 5��� —�(C-K:—C� <br /> Proposed Usc of f3uilAm9 Conlnc� Person (Plan Review� <br /> Descrip�ion of Work lo Oe Done. ( !i[�F�/�l'� ��F�- /(/ /�'��-�G� K'y ��/ ��"'"'��� <br /> _j-_a�s,����,���f-�r��.� � ,� <br /> NOTf_ WIRING IN IJON-D�VELLINGS IS R[QUIRED TO FEE <br /> D[ IN Rl�CEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SAL[S TAX CODE IS 3105 <br /> 1 hereby rr,i}il��(haf I havc reaAanAcx�mineAfhis npplicntion and knuw the seme to be fnie anA <br /> correcL All prowsions ollaws end ordmances gove�ning Ihis t}�pe ol�rork irdl bo completed <br /> 1VhC(IIO�5(7n,CilICAIIBf(?61 Of/IOf. TIIO[JlJlihfi(J O/A(JClf�ld AOCS IIO( vesunre fo give aufhonfy to <br /> violnte or cancel lhe Iuovisions ol eny ofher sfafe or local law iegulafing construcfion or fhe <br /> pedormance ol constniction. Thof 1 em nufhorized by tho owner ol fhis properiy ro peAomi fhe <br /> work!o �hich eppGcefian is made nnd 1 r.ompty wifh fhe Sfnte ContrAcfors Law 18.27 RCW anA <br /> 2962 AC. <br /> I ` ` <br /> Signaturc Uala <br /> F ��io4-o y& <br />