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f � 3v -o � <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-b810 - FAX 425-257-8857 -www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM 70 4 PM <br /> � - ;v G <br /> �' `i lL (,. ���+ /�v'�. l Fve/e7� f� S V''c u-����.-� .. r 1������+��.� <br /> , <br /> PRQJECT ADDR�SS <br /> °i< < �S = '1/'iC <br /> ,_ �- <br /> r l/('/C�� SC�i�'�: � !i i S-f/r C � >7/ 5 �i'�: 1(F� l-�vC ,;�✓��c'� l✓t� �c�=� ! <br /> Owner Mail Address Clty Stale/Zip Phone <br /> 4Z_s`-355 Y/�6 <br /> i=v�,�� �f �I, �/, s��.��•�/ ?_ yl[ CCl6� Ave i v��r�f� 1��/� `�='��l <br /> Tenanl � Mail Address City Sta1e/ZIp Phone <br /> t�!'!�l�> .S-/z;-�e �/r�-�i��� , Z.�c. Muk�l�te� l�/r1 `�k=-, ,� 5 <br /> [lec�iical Conlraclor Mall ddress Clry State/Zip Phone <br /> .�'7�j'���- / /."I �. J �i-. "-C 5�,� ���. ,�-2.'_ <br /> Stato Licenso Number � Conlracl Price o(Work <br /> ���i 5� /<;�',�r+ i — <br /> Proposed Use of Buildlnp Conlacl Person (Plan Revicw) <br /> Descriplion of Work to Du Dono: d CC'M��i� r�� i S f i� i �!C f/��'.o� S �2� <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC GR AC CABLE. <br /> CITY OF EVE!2ETT LOCAL SALES TAX CODE IS 390F <br /> !hereby certily thaf 1 have rend and ext�mined fhis applicafion and know fhe same fe U�true and <br /> correct. AN provisi�ns ol laws and ordinances�oveming this type of�rork wil;be completed <br /> �rhefher specified herein or nof. Ths�ranting ol a pernut does nof presume fo yive authonty!o <br /> violafeorcancelthe provisionse/anyofherstatoorlocalla�. regwafingconstrucfionorthe <br /> perfomiance �I construction. Thaf I am authonzed by the o�vner ol tltis�roperty fo pedurm the <br /> u•ork!nr which application is made and 1 comply wi(b the Stafe Contrac7ors Law 18.27 RCW and <br /> 296.200 WAC. <br /> , ' l ,_ <br /> �,' � ,--,f l �u � �7 � <br /> Signature �ale <br /> i l,;rl ` �`, <br /> � <br />