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/ �_ <br /> l <br /> ELI�CTRICAL PERMIT APPLICATIG�N <br /> CITY OF EVERETT PERMIT SERVICES � _ a�_ �� <br /> 3200 CEDAR STREET, EVERETf, WA 98201 �� �p 1-/� <br /> 425-257-8810 - FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> C!'�� �� L3/�•�c� <br /> Zqzy - µ � <br /> "/�� S� ��,-� �� l�td� <br /> PROJECT ADDRESS <br /> �h�- nf'�JPrc�7 r'/��� ��(� ZZO-1J27 <br /> Owner Mail Address Clty State2lp Phone <br /> C;,�� „L� r�'�,iP.��T <br /> Tenant Mai�Address City State/Lp Phona <br /> ,A�J�n�r,�i�!�'E.'� -7' �,+� yQl�� �S r�`� s'f-/f/�2" ✓'�t�� _s�,.�/�� 9b'L�� <br /> Eleclrical Conlreclor Mail Address City Stal ip Phone <br /> � V �.��� Q�S�� <br /> Stale License Number Conlract Price of Work <br /> �to cr�o a,c / J�A./_)„�.r, <br /> Proposed Use of ildin Conlact Person (Plan Review) <br /> Description of Work lo De Dono: ,L�S�rZU' R'Jl�t�-2 �n 0✓�lr�-- � �AJc�i UC��7f� <br /> > ,r-fir,/ t <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 /> 1 hereby certily fhat 1 have read and exnrnined Ihis application ond kno�v the sarno to be Iruo and <br /> correct. All p�ovisions of la�vs and ordinancos ga�emina fhls type o/n�ork wi/l be complefed <br /> �vhether specified herein or noL The c�ronfin�of a perrnd does not prosume fo give aufhonty(o <br /> violate orcancel tho provisions ol any ofherstato orlocallaw regulafing construchon or fhe <br /> I performance of constn�ction. That 1 am authonzed by fhe owner o(Ihis property fo pedomi thQ <br /> �vork for which applicafion is mado and 1 comply�vifh Ihe State Confrsctors La�v 18.27 RCW and <br /> 296.2��wA�. �' O I _ l 3 0 <br /> / <br /> �-�� � ,�..�2 ��z ��i�' — <br /> Si�naluro Date <br />