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ELECTRICAL PERMIT APPLICA710N <br /> CiTY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 �` a7-o� <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org b OgOg-1� �j <br /> APPLICATIONS ARE ACCEPTED FRONi 8 AM TO 4 PM <br /> � <br /> ;0 [ a I � v�rG2���� G�J A ( � �� <br /> PROJECT ADDRESS <br /> U�l�1.� ��`i ���'V�I\�1 %��.;(i �'��'<.' <br /> Owne� Mail Address Cily StatelZip P1;one <br /> Tenant Mail Address City StalelZip �z�,i:. <br /> I� � (� (J� ING �'LE�i��r_ loy i��� �� �� 5'�l L�N,��u�ue� , w � %'�%d4` <br /> ElOctriCal Conlracto� Mail Addmss City StalelZip Fhone <br /> ' —� �— I(� <br /> �) I? ( �n== � D �O I ,�i � �oG . c � <br /> State License Number Contract Price ot Work <br /> , <br /> ,�/��I1C=�?CcAL �; �A��� (ZiD��•�G <br /> Proposed Use ot Building Contact Person (Plan Review) <br /> /.� . <br /> Description ot Work to De Dona l��( !�v � ���'-� n'f 7 L�L J •'�:'✓� iU F G..? <br /> `�� � 'T C�-�( r�d"z 1,�0 (Z rc �S�''�lq /���� G(iv� �S�i�'7—�r.�V <br /> �;� KJ �t,� �—�; fi LL <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby certify that 1 have read and examined tbis application and know fhe same fo be frue and <br /> correcL Al/provrsions o/laws and ordinances governmg fhis rype olwork will be completed <br /> whefher spec�6ed herein or not The granting o/a permd does nct�resume fo give authonty to <br /> violate or cancel the provisions o/any other sfate or loca!law regulating consfruction or fhe <br /> performance o�-cpnstruction. That 1 am authorized by fhe owner o/this property fo peAorm fhe <br /> work Ior yv iich applicatioiyi,s made and I comply wilh Ihe State Contractors Law 18.27 RCW and <br /> 296.2p0-4 AC / / � <br /> j ,'/' C��E.��--, �; �_ ,� ,��� �p � ��o <br /> �� Signature !/ Dale <br /> � '`- <br /> I <br />