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� <br /> ( <br /> ELECTRICQ►L PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERViCES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 fd vI �� 09 <br /> 425-257-8810 - FAX 425-257-8857 -www.everettwa.org C OQ 0��� <br /> APPLICATIONS ARE ACCEPTED FROh1 8 AM TO 4 PM � <br /> / i <br /> /1�� , 3 z ���� ��2�� r �ac. ' `� � C �-- . <br /> � � l% ; <br /> PROJECT ADDRE�S <br /> �-,; <br /> L 7 <br /> 7 /ti S� I�(/� {%/c. �Z � .�'L���.�L'�L /-i':-� -JSQ„D iL, � �CcuC'�G�/�z ' � I' , <br /> Owner Mail Address City State/Zip , hone � <br /> ��� �� 3� <br /> ���-/'�-/� c;�}' � �S 1 //G:�Z F.d24 �/,�e,��c, Gc�c�<� �'U�� �,�i;�- ���� i� <br /> Tenanl Ma�i Address Cily ,r Stale/Zip Phone <br /> (/ <br /> ���� . 1�� �_ �1a �J���� � �- i��x ����5 s��>���� w� �� �� � <br /> ,� <br /> %ectrica Contrector � M�I Address City S�ate/Zip Phone <br /> ��t� ���� Li y U��>� �v �� _ <br /> State License Mumber Contract Price of Work <br /> Proposed Use of Building Contact Person (Plan Review) <br /> � 7 � <br /> Descriplion o(Work lo�e Done: � ���� C�� ��'�-- ��'��L"����' ���G��� � � � � <br /> ��_ ;��L.L � �'� G, ,� f L; �:� y,S�—��C�� �T��/J �� ��{'i����� zY� <br /> j J <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CP.BLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 ��I ��r� <br /> 1 hereby cerli(y thaf 1 have read and examined this applicatiou and know the same to be true and ZS <br /> correcL All provisions o(laws and ordinances goveming this type of work will 6e completed <br /> whether specified herein or noL The granting of a permd does nof presume to give authonty to <br /> violafe or cancel lhe provisions ol any other sfate or local law regulating construction or fhe <br /> perfomtance o/construction. That I am authonzed b}�the owner o(this property tu pedomi the <br /> work!or which application is made and I comply wifh fhe Sfate Confractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> , !, <br /> i ;'%�!C.'Z' �'�:�<''.,�.'C�'�t/ � ��L�/ d, ��; / <br /> Signatu:e / Date i <br /> / <br /> � <br /> ' <br /> ' -- <br />