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� <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 � 2 `?2— f D <br /> 425-257-8810 - FAX 425-257-8857–wHnv.everettwa.org C f 01'2 • �3� <br /> APPLIC"�TIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> ,��`�DO �—I W `� q� 5 �1����� <br /> PROJECT ADDRESS <br /> /�Ql'v�Wl1�'A�'Cf£ �cllrll�� �/�.�JO NUII��� 4�ISlZh'Y/ 6U I��"`��Z��j �i1�,5�i�� 6S <br /> Owner Mail Address City State2lp Phone <br /> Tenant Mail Address City Stale/Zip Phone <br /> A��NTrt�2 t}cr��7,�cc �'�b'y5 �,�.��a2 Q►�- aoc..� wl� q823y 3i�-9's�-�3m <br /> Eleclrical Conlractor Mail Address Gly State.2ip Phone <br /> I�J�/V ��1 `" `T �� 14 J/l ���I�'V� <br /> State License Number Contract Price of Work <br /> G�1U�� R�/N<fz�2 <br /> Proposed Use of Building Contact Person (Plan Review) <br /> Description of Work to Bo Done: l N S7�-L L ( `tf �'(,l�C 7 n.� G (J���< </� <br /> G ���2 ��� � b� ���5 <br /> �'OTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACE\NAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby certily thaf 1 have read and exarnined this application and know fhe same fo be true and <br /> correct All provisions of laws and ordinances goveming Ous type o(work will be completed <br /> whether specifred herein or noL The granting ol a pemut does not presume fo glve authonty to <br /> vio/afe or cance/the provisions of any ofl�er state or local law regulating consfrucfion or the <br /> per(ormance o/constniction. Thaf 1 am authonzed by the owner o/this property to peAorm the <br /> wak lor which applicatron is made and 1 compty tvith fho Sta:e Cont�ac(ors Law 18.27 RCW and I <br /> zss.zoo wao. / D I� _ �3 % <br /> /�,��� '� " � � ' �� <br /> SignaWre Date <br />