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ELECTRICAL PERMIT APPLICATI�N <br /> CITY OF EVER�TT PERMIT SERVIC�S <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX425-257-8857 -www.everett�,va.oig U�-��d� <br /> APPLICATIONS ARE ACCEPTED FROM 8 PM TCI 4 PM ��g��_C�� <br /> � � .Lll �'�✓1/� (';-i�.(,'n ��i9.• `� 7 C ���z-'�� , w �. `�rf .:� U � <br /> PROJECT ADDRESS �� <br /> < ' � �( i S��.r��0/ <br /> /I/ r ,�7� 7 �5 �' / .:�; 7� ���� <br /> ,, ;,� �: .� -, �-., ro�. ' f <br /> ��XA1 1' s�..n,..`T 1✓1" T <,1� . �L Li/ �SilU � � r�-- <br /> Owner Mail Address City State/Zip Fhone <br /> r T '� <br /> i^ / <br /> / ' ) . % ��� �l i�.'vf7�1. �2�.F�t ff�i � i <br /> (! /Y ,1 < NG � S AG �� �'i/G:�-�' ��-rl �Lvei� `._� <br /> Tenanl Mail Address Ci1y State2ip Phone <br /> f i_i 1 I / �� � ���. �. <br /> S"T � .�� c.,�;zFl , k� s) �7 � � • >� �G � <br /> P � �t-�-� , �✓,� t�c2�� ( <br /> Electrical Contraclor Mail Address City State/zip Pnone <br /> (��'� r j_ %c -x i:},� fj �z - ��; - _ <br /> Stafe License Number Contract�Price of Work <br /> Proposed Use of Building Conlact Person (Plan Revie�v) <br /> iDescription of Work to rJe Done: I7� X ,5��✓� CL . l�-� X�..�� <br /> NOTE: ;NIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN R,4CEWAYS, MC OR AC CABLE. <br /> I <br /> I <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceRi(y that 1 have read and examined fhis applicafion and kno�v the sanie fo be true and <br /> correct. All provisions o(laws and ordinances governmg this type ol work wi116e comp/eted <br /> whefher speci�ed herein or not The granfin�of a permit does nof presume to give authority to <br /> vio/afe or cancel the provisions o(any other state orlocai la�v re�ulafing construcfion or fhe <br /> penonnance o(cons�ruction. That 1 am aufhorized by the o�vner o/Ihis property to peAorrn the <br /> work for which applicafion is made and 1 comply with fhe Sfate Conlractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> �'_� C%" � r <br /> \. �—.. �� � S � J <br /> SlgnaWrG Date � <br /> (/ � � q <br /> J ��� ' � � � <br />