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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 7—/ �"�6 <br /> 425-257-8810 - FAX 425-257-8857-www.everettwa.org �=p 66 7—v� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> �-�(�Ik ��'r�I !�� � �,C <br /> PROJECT ADDRES� <br /> ��1� � �1a�" � ���,'U '� (��J11.�_� I�u� f Vcl��� c.:' :`� <br /> Owner MailAddress � Clry State/Zip Phonc <br /> Tenant MailAddress City State2ip Phone <br /> /�\ h �� 'a 77 <br /> LTI�JT ��cC� (i� �QG3 `7Ut�" �� C .S✓lo{'le :�..o!^ � , ' �t 1�G)5G �3i5 <br /> Electrical ConUacbr Mail Address City Slale2ip Phone <br /> i�)c:�-���c �t�shJP � �L�a� ;�� <br /> Slate Licenso Number Conlracl Price of Work <br /> rC��.��P1(' t ��✓14�e= � V�� � \ <br /> Proposed Uso of Building Conlacl Person (Plan Review) <br /> Description o(Work lo Be Done: rE ' k�� �� n r .S F 1� C���"�J ,C � �C�V Ss 7 <br /> NOTE: WIRING IN NON-DWELLfNGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. ,� — <br /> �^�- <br /> CITY OF EVERETT LOCAL SAL[S TAX CODE IS 3105 <br /> !horeby certify fhat I have read and exarnineA this applicafion and know ihe same to be true and <br /> correcf. All provisions ollaws and ordinances governing this ty/�e oI work wilf be complefed <br /> whefhor specJied herein ornot 'fhe c�ranfing ol a permit does not resume fo give aidhonty fo <br /> violate or cancel the provisions ol any other stafe or Ioca/law reguPfint�consW ction or fhe <br /> pe�formance o!consfrucf�on. That 1 am authorized by fhe on•ner o/fhis�roperiy(o peAumi fhe <br /> work�or whidi appli afion is made and 1 comply wifh fhe Sfate Confractors Law 18.27 RCW and <br /> 29G.200 WAC. <br /> 4� `____ ';— ----.. _ G� 7 G <br /> SignaNPb` �� a�e � <br /> � �'. <br /> ��,�7. <br />