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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES � _�q_�� <br /> 3200 CEDAR STR�ET, EVERETT, WA 98201 <br /> -�25-257-8E10 - FAX 425-257-8857 —wwvd.everett�va.org C jl�� `�O� <br /> APPLICATIONS ARE ACCEPTEO FROM 8 AM TO 4 PM <br /> • ,'�( �' � 1�� _l �.'��J�. ! �lv���-- <br /> PROJ[CT ADDRESS <br /> Ovrner btail hddross City S�ate;Zip Phon� <br /> e K_ a7c>� ee�� � � w� ��c;�- <br /> Tenan��� Mail Addr¢se City State2ip Phone <br /> ��L,U ) <br /> -j � r: 1`l - i � �ll:n �Jn �ik�3U L�7i- � 3�13 <br /> Electrical Con actor Mail Address Gty Slate2ip Pnone <br /> `�i C---���,Pi ��,�,��< lo/iz�i2 -� L�, �;c�c� , n�� <br /> Stale License Number ConVact Price ot Work <br /> �`I'�`r:� ���l.� f�t <br /> Proposed Use of Building Conlact Person (Plan Review) <br /> Description of Work to Be Done: C'„�IC�f'o �'�J�1-5 C'I�z n��o I L " Y `�.7�°n�i`��(J1G,i� lu.���. hc'�� <br /> � , n (1 � 31�� :rI � � ��nl J. 'T `I <br /> �� <br /> �;� �, -rc�c! �<=,-��,�� J <br /> NOtE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, ti1C OR AC CABLE. <br /> CITY OF EVERETT IOCAL SALES TAX CODE IS 3105 <br /> I hereby certily ihat 1 have read and examined Oiis application and know the same to be frue and �`( C���— �(�� <br /> conecL All provisions o!laws and ordinances qovemmg this type ol work will be compleled � <br /> �vhefher spec��ed berein or noL The grantin�ol a pemul does not presume to give authority to <br /> violate or cancel fhe provisions ol any other stafe er local law mgu/aling constmcfron or Ihe <br /> pedormance o/consfrucGon. That 1 anr aufhonzed by lhe owner o/ih�s property to pedorm tho <br /> work Ior H�hir.h application is made and 1 compty with fhe Sfate Confracfors Law 18.27 RCW and <br /> 296.20 AC. <br /> i i <br /> ,�. � � ��- �, �� ,, <br /> Signatu ate <br /> � <br /> � <br />