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� <br /> ELECTRICAL PERMIT APPLICATION I <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX425-257-8857 -www.everettwa.org C� _s._o8 <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PNI �=Q��py <br /> ., / <br /> L�'UJ � ��/�y ��v� <br /> PROJECT ADDRESS <br /> L s�-S�� O <br /> ,�,�o i a�L �c��I� �S �,�>i� < l t7 7 C����� N�� ��E,�E�i �� �r��� <br /> Owner tdail Address Clly StatelZip Phone <br /> �a�;���;,v ,LC'.:��D�,v�v 1�d,S C�7��Y �� L dE�EJ�y wA yrS'z�i �r�S-7.� _�� <br /> Tenanl A1ail Address Ci1y State/Zip Phone j <br /> � <br /> EICCUical Conirar,lor Atail Addiess City SlatclZip Phone <br /> Slalo License Number Conuact Pnco ot Work <br /> Proposed Uso o(Building Contact Person (Plan P.eviow) <br /> Descnption of Work lo Do Dono� l C�� / /'� / 5 � � J�v� � �iTr � `� " �/ <br /> i � <br /> ✓ <br /> NOTE WIRING IN NO(J-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OP[V[RETT LOCAL SAIES TAX CODE IS 3105 <br /> 1 here6y ce�fi/y fhaf 1 have read nnd exa�liined this applicafion and knmv fhe samo fo be truc una <br /> correcL A/l provlslons o/laws and ordinances goveming fhis type ol work rvill be compfeted <br /> whether specilied herein or noL The granfing ol a permd do�s nol uesume to gi��e aidhonty to <br /> viotafe or cancel tho/�rovisions of any ofher slate er local la�r regulafing cons Wc6on or the <br /> perfomiance o(conslruction. That I am autho�ized by Ihe owner o/this property to peAonn the <br /> work lor which application is mado and I cornplf�;u'ifh the State Contractors Law 18.27 RCW and <br /> 29G.200 WAC. <br /> i <br /> :/ � c- / — <br /> ��� ,�(��j G�� �/'_ <br /> Signalure Uatc <br /> i G�G�t-v�"� <br />