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ELECTRlCAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES � _�y..pc� <br /> 3200 CEDAR STREET, EVERETT, WA 98201 / <br /> 425-257-8810 - FAX 425-257-8857 —�•�ww.everetiwa.org C�07—o02 <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> �,' � � r� / . , , . �:/� ,� <br /> ?ROJECT ADDRESS <br /> Owncr hlail Addres�� City �\ Stalc/Zip Phone <br /> I•. �l�r l.�o/ /°7r��CJ ���•rl <br /> (��; n �F �Jqn �( UJ�� C� �v�/�J/�Cq ��G�I L-vCI�� �9 /D Zv � <br /> Tenanl Mail Address Cily SUle/Zip Phone <br /> — ��j ,;6v 75'7 i3o 0 <br /> J / . 7 C���1 � � �� (/ <br /> �� :'�•.� j:i �'�r� y•;� �✓ O J �c o / oUi WtJ� y�.�,'C� <br /> Eleclrical Contraclor Mail Addross Gty State2lp Phona <br /> ,�� ,•, ; �. ; /��' ��:- (5� 3i I�) y, os� -" _ <br /> Stale Liconso Number Conlracl Prico of Worf; <br /> i <br /> . /.�.-. a i/i . <br /> Proposed Ustt ol8uilding Conlact Pcrson (Plan Review) <br /> Descriplion o(Work lo�o Oono: ���n �/> ZV A c i i c r.{ .�..•�, !i�f /� �� <br /> � �r � .i/r .. C-'� �- c� �Jr.>�� 0 1' ��ro� f-�7�y ��J 1ic.� /�;�.,` <br /> s <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 /> !hereby certily thaf I havo read and exarnined fhis application and know tho samo fo be Iruo and <br /> correct All provisions o(/aws and ordinances govemaig this rype oI�vork will be comp/eted <br /> whefher specilied herein or noL The�ranfing of a pennd does rwt rosim�o fo give avU�onty(o <br /> violato orcancel fho provisions o/any otherstafe orlocallaw reguPting construcfion cr Ihe <br /> pedormance ol consfrucfion. Thnt 1 am euthonzed by fhe otsner ol this property fo perlomi fhe <br /> �vork(or which a plication is mado and I compty�vith fhe Sfafe Contractors L��v 18.27 RCW and <br /> 296.200 WA ,, <br /> � j � � V <br /> I p/v ?�i��/� q (� � � �' <br /> / Signalure � Date 1nl � <br />