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�' � <br /> ELECTRICAL PERMI� APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 �� -/2-IJ <br /> 425-257-8810 - FAX 425-257-8857-www.everettwa.org � ���2 � rl/ <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> y/�O �'up��r.�� L,��'�h�� <br /> PROJECT ADDRESS <br /> 0c�e-�/'WrcY � .�305� �-�'� dO�o /�'i`�D 4�o,?a�f <br /> /�S,�G, Gc�,t�e c.. � Lc_a� �_ a, Gc/m /a3 <br /> Owner � Mail Address City State2lp Phone <br /> l�'lU G-!J y�i� �".�r-4�eev 1,�1m� ii�v�f� <br /> Tenant Mail Ad resa City Slaterzip Phone <br /> ao � <br /> G�P F.'.��r����.���_�i u� Q5�'�i 5��!Fl� �2 i/� a� oi� <br /> Electrfcal Contracto� Mall ddress City � Stale2ip Phone <br /> ��� <br /> G n�R r r�� ��s �b N � <br /> State License Number Contract Price of Work <br /> R�f��/ . <br /> Propose�Use of Buildfng Contact Person (Plan Review) <br /> Descrlptlon of Work to Be Done: .— <br /> /Od A'�l0 J7��-2 r�//C. � D P )C/'S�/IVA V�/�� <br /> �c� ���L� �.-erUlc P �d o�,�s�inc� �.e-��� <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. � ��GJ� <br /> / <br /> CITY OF EVERETT LOCAL SALES T/4X CODE IS;105 <br /> 1 here6y certily that 1 have read and examined thls r:ppllcaGon end know the same to be true and Ci ` � ( Z��7 <br /> correct. All provlslons of laws and ordlnances goveming thls type of work wlll be completed I <br /> whefher specifled hereln or not The grenBng of a permrt does not presume to glve aufhonty to <br /> vlolateorcancelthe rovlslonso/anyotherstateorlocallawregulsHngconstructlonorthe <br /> peAormance o7cons�ructlon. That 1 em authorized by the owner o/Ihlsproperty to perform the <br /> work/or which appllcatlon!s made and I comply wifh the State Confrac(ors Law 18.27 RCW and <br /> 296.200 WAC. <br /> ��� ��.��/ <br /> ���gnat� Date � <br /> �� <br />