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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SER��ICES y_6_og <br /> 3200 CEDAR STREET, EVERETT, WA Sd201 // <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org �oyo y���Y" <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> ..1 � � � % LG �'/U ti��,'�. <br /> PROJECT ADDRESS <br /> yzs= � . i= <br /> / 7 /7 / ,/f ! J4' �Y�"l� O .� �7 <br /> IC /-1 ;- Pt� /J I/l/f�S� S�✓�r,G- � � <br /> OWnef hlailAddmss Cip� Slate/Zip Phone <br /> Tenant A1..il Address Cily State/Zip Phone <br /> � � ^ '� <br /> �leclrical Conlractor Atail AdJress Gty State/Zip Phone <br /> State License Number Contract Pnce of Work <br /> Proposed Use of Buildinc� Conlacl Person (Plan Review) <br /> � / , <br /> Description of Work to Be Done: �C �'''Y/7—//L /�lJ�v �..0/fsr' S �'i/l��C_.e— <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 COOE IS 3105 <br /> I hereby certi/y thaf I h+rve re;�d and exarnined this applicati�n and kno�r the sarne to be true and <br /> correcL All provisions ol/aws and orCinances govemmg Il�is f}�pe o/�vc �vill be complefed <br /> whefher spe�died heiein or noL The �ranting ola pernut does not restune fo give auBionty fo <br /> vio/ale or cancel th�provisions o(any other sH!s or local la�v reguPling construthon or fhe <br /> periorrnance o/construction. That 1 am aufhor�?ed by fhe owner o/this property to perform the <br /> �s�ork lor�vhich applicafion is made and I wrnply with fhe State Contiactors La�v 18.27 RCVl�and <br /> 29G.200 WAC, <br /> I �' <br /> , <br /> ' � «�,C���� 1 �' �� `�`���- �, �j <br /> -Signature Date <br /> �09o�1-a�`( <br />