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� � <br /> � _ ---- — — - - <br /> ELECTRICAL PERMIT APPLICATION <br /> � � GITY OF EV�R�TT P�RMIT SERVICES <br /> 3200 C[DAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-6857 —w�w�.evereltwa org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM C� <br /> 9-��� z <br /> L�/ Z�J�`d I � <br /> ��1.�3 �.�1ljv� /�ri�t-. G,,r,rcr�t•Il . �'r� `,Y%vi <br /> � <br /> PROJECT ADDRESS <br /> �'kcfc,Qal ���c�l'�,:.:-S (i,C, !17�? C�Iy ��e. a�e, l')x� G�����. �tn4, �i(rL�G� . ut�-Z�"z ,�o� <br /> Ov+ner tda�lAddress Gry State�Z�p Phcne I <br /> �;n�cs'anaa ��u��� �,33 C:�y�, �fi'� �+�c��c� , �t'� ti'S't�l N�L�-343 ��f-3��`�. <br /> Tenant MadACdress Gty Slate2�p Phon; <br /> �C'�,�� I'�-� `�J�i��rz�v,�z� 31�'1 C'6�1.i.��(�if� 'Ji^iV1. C�i�./L 71U�rVJ- !'V�'� CIY1�Y �LS-z!!3 �l�' �7 <br /> Eleclri�,:alCoNracter ASa�lAddres, CAy Sta�e2�p � Phone <br /> , <br /> .50C�.--. <br /> /v/�9� T.��trc_ ��'v'ft�u��ut� u,�-� . <br /> Slate License Number Contiart Pnce ol tiNor� <br /> �f rG�Gt 6Clil'} _ �Kl��I'1 {� !�i!'lC�_' 4k1� _ <br /> Proposed Use of Duilding � Contact Person (Plan view) <br /> r,t�-c� i <br /> Square Footage (If rnsiCenhal new consiruction,remodel or adddion) i <br /> � <br /> (��� ,� �r'� I <br /> Oescription o1 Work t0 Do DOno: C'iU:�����ct� C�1c'�vt.'L3 �iN, i <br /> ) i <br /> NOTE: WIRING IN NON-DWELUNGS IS R[QUIRED TO FE� � <br /> BE IN RACEVVAYS, MC OR AC CABLE . �� CjU I � <br /> �i i <br /> CITY OF EVERETT LOCAL�ALES TAX COOE IS 3105 --- I <br /> 1 he�eby ceRdylhat l l:ave read and examined this apphcafion and Anow the same to be trur, and � � �OQ _ OQ� <br /> correct All provisions ollaws and ordmances govemmg Ihis type o!�vork wdl be complefed I l <br /> whefher specrfied here�n or nof. 7he granLng o/a pennd does not�resume fo give aufhonly fo <br /> violafe or cancel fhe provisions o!any other s(afe or local law regc�ahng consfruc6on or fhe <br /> perlomiance o/construction. That I am aufhonzed by Ihe ownero/lhrsp roperty fo perform tlre � <br /> woik/or�vhich epplicafion is made and 1 comply�vifh the S(afe Confracfo�s La�v 18.27 RCW and , <br /> 296 200 WAC. <br /> . <br /> !��"' R' �� �--� _ � �s I L <br /> Si�natwc / �' �� <br />