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f <br /> ELECTRIGAL PERMIT� APPLICNTION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVEREl-f, WA 98201 ?j a 3`/O <br /> 425-257-8810 - FAX 425-257-8857 —www.everetlw��.org �/OD �j—�(� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> ��;/�O �G�G'Q�'-�'-!�l �¢, �E S`" �l�,�l��� �� �? <br /> ,� <br /> PROJECTAUDRESS <br /> (�/ ��T�>-�2 (_L�jtJ l � '�Z�S/�1�^ <br /> 2� •z2 <br /> Owner � Mail Address City Slate2ip Phone <br /> G�f¢c�z-� �"-�G�J d.P <br /> Tenanl Mail Address City State/Zip Phone <br /> v�� <br /> cz��i�,-�,>, �T�� s����� ,���..,�/s�, �-urr/ ,��i: , s���r 3�3e_,?crS <br /> El�clrical Conlraclor Mail Address City Slate/Zip Phone <br /> n � r-�� �--�,r��r � ' �' <br /> State License Number Co racl Pnce of Work <br /> Proposed Use of Building Contacl Person (Plan Review) <br /> Descriplion of Work lo�e Done: � Gv /� /�� ��o fS� �G S� <br /> � <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> 8[ IN RACEWAYS, MC OR AC CABLE. <br /> CITY GF EVERETT LUCAL SALES TAX CODE IS 3705 <br /> I hereby certify fhaf 1 have read ond examined Ihis application and know fhe sarne fo 6e frue and <br /> correcL All provisions o�lmvs and orclinances govoming this type ol work will bo complrfed <br /> �vhefher specilied herein or noL The c�ranting ol a pernuf does not presume to give auti.ority fo <br /> violate or cancel fhe provisions o/any ofher slate or local low re�uleting construcfion or tho <br /> performanse o/consfrucfion. Thaf I am authonzed by fhe owner o(fhls property to pedorrn P1�e <br /> work lor�vhich application is rnade and I comply�vifh the State Contracfors La�ti� 18.27 RCW and <br /> 296.200 WAC. � <br /> _ ,���..�.�� �i�°�/� - j --�3 --/a 1�3 -/l <br /> SignaWre Dale <br />