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( ' <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES p <br /> 3200 CEDAR STREET, EVERETT, WA 98201 6 `3'""� I <br /> 425-257-8810 - FAX425-257-8857 -www.everettwa.org � c�Ob ,Dl� <br /> APPLICATIONS ARE RCCEPTED FROM 8 AM TO 4 PM <br /> �- "� �' C��t tuf2c�T l�`A 98201 <br /> PROJECT ADD SS <br /> Owner Mail Addross Ciry State2ip Phone <br /> ��;-vn,�c- P�r,s ,�9�-9 co�r�ti� A�v� `��,c��E� �,.�a `'i62��� <br /> Ten3n1 Mail Addross Cily Stale/Zip Phone <br /> �ciP74 G� c.Fc.T12.If , LL� 7Q� 224 2V��� �2c+t��S54�Ltr 2 <br /> �- A4rF SE MNv�E va��e.� �t�la `78C73£ <br /> Eleclrical Contreclor Mail Address Clty Slale/Zip Phone <br /> �o iz.-r'� z L `13�1�F �' 5 00� o p <br /> Slale License Number Contrac!Price of Work <br /> Proposed Use of Building Contact Person (Plan Reviow) <br /> Description of Work to Do Done: 1�AL�f�`�T �411�I�C. � l LI6HT Q�T��F iT� <br /> NOT[: VYIRING IN NON-DW[LLINGS IS REQUIRED TO FEE <br /> !3F �N RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 i - , � <br /> ��.. (.:`I t,�4- �' ` 1 <br /> 1 hereby certi(y fhaf I have mod and examined this applicafion and kno�v the same fo be frue and <br /> COrtL�Cf. All proVi510/1s olltiw5 and orAinances yovemmg this t��pe o/�+rori;wil/be complefed <br /> whefher specil�ed herein or noL The granting ol a pemuf does not presumo to givo aufhonty fo <br /> violnfe or cancel fhe �rovisions ol any olh�r sfate or local lair reguletinc�construction or fhe <br /> perfom�ance oI cons�rucfion. 1h�t I arn aufhorized by fl�e ownor o�lhis property to perlonn fhe <br /> work lor which application is made and 1 comply wifh fhe Sfafe Confracfors Law 18.27 RC W and <br /> 296.200 IVAC. <br /> i <br /> �� � <br /> � .r<< c'�� ����0�'� i <br /> Sipnaturo Date <br />