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� � <br /> ELECTRICAL PERIVIIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CED:'�R STREET, EVEF.�TT, WA 98201 <br /> 425-2 i7-9810 - FAX 425-257-8857 —www.��verethva.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> �� - -� -� - � - � ��� <br /> ,_'j _->(_: �'����rc�mr � I,.,�t_a -��ae'_C� <br /> PROJECT ADDRESS ` � <br /> y�5� ��h <br /> �e c� l�e�� r- S'S �c L ,T, ,.,� �ti��4 Cv��e 11' C�i'� 9��C�/ Qv'�c <br /> O�.vner rdailAddrcss Ciry SWte,tip Phone <br /> � Tecant Ma��`�.ddress Ci'. State2lp Phone <br /> 3[a• <br /> �����et' G�ec �i'iLartc l3h'�/��L�ctfP� (2C� ��� CcJ/l %�d3� 757-/30(�� <br /> Electrical ConVacter 6fail Adtlress City State2ip Phone <br /> I�•7T-n�TE_Z i�1E'��� � ,:�Cn',c'�J� <br /> State L(cense Number ConVact Price of Work <br /> 1'C � �"i'..� � Gen e �n �n,f- - <br /> i <br /> Froposed Use oi Building Contact Person (Plan Review) • <br /> �-- I� 1 _ I <br /> Description at bVark to Be Dono: —/-/1�,}�1 �' �siJ� (lct rl P �, � G��iS an n f 2,'� 1TI��o <br /> c�, ��e._c�,: -� �n� �{ . ,ia n� '�,O c�C,C' — - - — - <br /> � <br /> � NOTE: WIRING IN NON-DWELLINGS IS REOUIRED TO FEE <br /> BE IN RACEWA i S, MC OR AC CABLt. <br /> � <br /> I CITY OF EVERETT LOCAL SALES TAX CO�E IS 3105 <br /> � I hen . cer,�;�thaf 1 have re :, nramined this a:; ::� •�nd know lhe ++�,e t�`� frue and <br /> rorr� Ai�pio. •:r�ns ol/ac. . �;..: �re, >nces gove r.:;�;nis ty;;a o/work�._. ue com;.::ted <br /> �vhefher specified herein or not Tne granting o(a p�rmd does notp resum,e to give au[honty fo j <br /> � viclate or cancel the provisions ol any olher state or ocal law regulating construction or fhe � <br /> � pedormance o!construcbon. That I am aothonzed by the owner of this propeRy to peAorm the � <br /> :erk(cr which application is made and 1 compty with the State Contrectors Law 18.27 R�W and � <br /> ?96.20D-WR <br /> � �_ - i <br /> � ' ,L. � � <br /> �-- �ti ,�._"f(t _� . -.,-._._,,-, � � <br /> i , S�gna;ure �at> <br /> � <br /> � <br /> �' ��-_-y <br />