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ELECTRIGAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVIC�S <br /> 3200 CEDAR STREET, EVERETT, WA 98201 G� �3 --�0 <br /> 425-257-8810 - FAX 425-257-8857 -www.everetlwa.org ��Q�g`O a� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TU 4 PM <br /> ZZ � 2 C O I � A-Va(�' <br /> �'t� )�/ � )' .' tirc e 1 " - <br /> PROJECT ADDR� �� <br /> Owne� Idail Addmss City Slale/Zlp Pnone <br /> (�o �IUy Tr�': Y���� �� 21 ('D��Y f��E �Ue1're � 1.U/� `3�;d 'L � . <br /> � <br /> Tenanl � � Mall Address City Stale2ip Phone <br /> )oll��S p�w���- � ��c� Z� t< �Fc, ,��1 t.t/ �y-H�- ��d �� . <br /> Electrical Conlracto� Mail Address City Stale/Ztp Phone <br /> c+� , <br /> .� 7�� _g ���� <br /> Slale Icenso Num er Conlrecl Price of Work <br /> Proposed Uso of Duilding Conlact Person (Pian Roview) <br /> Jescriplion oi Work lo Bo Dono: � ��i C L_ � � �� E �l��� ' <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> �E IN RACEWAYS, MC OR AC CAf3L[. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> 1 hereGy certily fhaf 1 hav�read and ez�rnineAthis applicafion and know Iho same to be truo and <br /> correcL A;l provisiais o/la�vs -�1 or�inances gave.nmg fhis typo oI work will bo compfetnd <br /> �rhefher speufieAherein or n Ti'ie granfing o(a pennd does nof presumo fo give aulhonty to <br /> violate or wncel U�o �rovisf ns ol�ny other sfsfe orlocal law regulating construcfion or fho <br /> performance o(cau�rucfio . Thof 1 am putho�ized b}�fhe onner o/(his property fo pedom�tho <br /> work lor n�hicfr applicafio�!is maou and I comply wilh the State Confracfors law f8.27 RCW and <br /> 296.200 WAC. <br /> 1 <br /> i�- .�,� � z� � � , <br /> � Signaturo ; . Dale <br /> •�IUG�i- C��I <br /> -- . <br />