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�.. �.. <br /> ELECT9�ICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMiT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 6 ....(�...d� <br /> 425.257-8810 - FAX 425-257-8857—www.everettwa.org ���0 /�� <br /> APPLICATIONS AR�ACCEPTED FROM 8 AM TO 4 PM L <br /> J � � 2 � <br /> �1.�-�� -�Ve�S�e�e �/��. M �f� z Z <br /> PROJECT ADDRESS � <br /> Se4 1 V` I 0� 1(4�4 Mai�dr /�lJ�//��lol.��_, 4 G_('I Y�_s�a�'P (O(1 / � Phone <br /> Y(� D _ <br /> TOnanl MailAddress City Sta(e2ip Phone <br /> �/�tG �/ea�`�';c q929 �i�sf('�'cl`—�,�r, �ar/'�•/q !� 9�e33 � - at <br /> Eledrical Contractor Mail�ddress ily S�ate2ip Phone <br /> ��, � � �r�o � � -s-c, _ T-+-�, q�.�r '�; d�a <br /> State License Number Contract Price of Work <br /> �l C 1 9 i� (5��+�n•ti �/'w✓t.� <br /> Proposed Use of Ruil�i�ig Contact Person (Plan Review) <br /> Description of Work to Be Done: ��ed a'4/_/�1 S 041 hr t✓ �eMtr�S�n� <br /> w4�1 gi�4 hCLi IU4TN✓0mr� �q/ir�bS <br /> NOTE: WIRING IN NON-DWEI �INGS IS FEQUIRED TO FEE <br /> BE IN RACEWAYS, MC,OR AC CA3LE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE �S 3705 � v G�� — D�� <br /> I hereby certily that I have read and examined this application and know the same to be true and � � <br /> correcL All provisions o/laws and ordinances govem�nq flus type o(work will be,completed <br /> whefher speafied herein or noL The gnnfing o/a permd does notp resume fo give authonty to <br /> vioiate or cancel the provisions ol any other sfate or local law iegulating consWction or fhe <br /> pedoimance o/conslrucfion. Tha(I am a�dhonzed by the owner ol this p�operty to peAorm the <br /> �vork/or which application is made and 1 comply wilh(he Stafe Con�ractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> 5,�; v L o,,.y ��� v _ �(D—0 6 <br /> Signaiure Date <br />