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ELECTRICAL PERMIT APPLICA�ION <br /> CITY OF EVERE7T PERMIT SERVi^�,ES �� _ � � :-�,6 <br /> 3200 CEDAR STREET, EVERETT, WA 98201 �G D y�� <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACI:EPTED FROM 8 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> :'" � ,32 Cc N�rrf',;°�i�� Av� ,, f v, <br /> PROJECT ADDRESS <br /> i"1 Gr��`7� /}� �'n �`� l <br /> Ownef A1�il Address City Statr_IZip Phone <br /> �' <br /> 7enanl Mail Address Ciry Slale/Zip Phone <br /> '1t 'C' f�(i�1tiT.� T (.IrGr �� �J� Y+9VI�S• �LVp. F'✓� lu./1- g137v� . 5i3-�'i� 9 <br /> Eleclrical CoNraclor Mail Address Ciry State2ip Phone <br /> ALSpuL,`�i�i'?-� I> (�,��j� s- <br /> Slate License Number Contract Price of Work <br /> S - h— r� <br /> Proposed Use o(E3uilding Conlact Person (Plan Review) <br /> Description of Work lo Be Done: rv 1'L,SI�f /�L< / f/= �— r1 eCZ ti <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 fhaf I have read and examined this application and know fhe same to be true and <br /> conecL All provisions o(laws and ordinances govem�nc�fhis rype of work�vitl be cornpleted <br /> a�he(her speafied herein or neL The granfin�ol a permd does not presmne fo give aufhonty fo <br /> violafe or cancel the provisions ol any other stafe or local la�v regulafing consfrucfion or the <br /> pmfom�ance o/consfruction. That 1 arn aufbonzed by fhe owner o/flus property to pe�form Ihe <br /> work Ior which applicafion is made and 1 comply with Ihe Sfafe Confractors Law 78.27 RCW and <br /> 29ti.200 WAC. <br /> � � ��-��� - � �� �� � - �0 � <br /> C�.v L;;�z�Crtt,�� ! � <br /> SiqnaWre Date / � � <br /> l� <br />