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t.. <br /> r <br /> , <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SE�VICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> 61 a a C�,�„,�.�,.�. A� c:���tf a s a�� <br /> PROJECTADDRESS <br /> �as-3� . 8c� <br /> fJ o�.� C�„-�-� Glo a�e� � S�� P��.�.,.� P,r�.� - i�a�� <br /> OWnef Mail Address Cily Slalc2ip Phone <br /> 1, L(1.S—��r ^ <br /> _��c ` t�QYp.2,� -I �-�--� � S� Cvtrt�ra�l�a-U3 3 pZb <br /> �� <br /> Tenant Mail Address Ciry StalclZip Phone <br /> tJ� c�va-c�*.� - -1'ti�� �v °u.�' nr-� Q� ��.0 _ <br /> Electfical Contractof Mail Addr s Cily StatelZip Phone <br /> State License Number Contract Price of Work <br /> Q�En-�'aJL_ <br /> Proposed Use of Building Conlacl Person (Plan Review) <br /> � <br /> Description of Work to Be pone: ► • 1�� � ''��''i'�`�'� � �u � ' ——1 ^�ilu"'�� <br /> (� c,..� U�-�" ,�,..°'E" ��1na (Yl�LtY �.�od r�s��.-s..�-�.. <br /> �..rnr�,. ��'—e- �..o.�—� o�.�- d'�`.:.o c�-�-L�a�-� <br /> NOTE: VNRING 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 certi(y that 1 havo read and examined fhis application and Mio�v fhe same to bo tnie and <br /> crorrecL All provisions o/lmvs and orelinances qovemmg fhis type ol work�vill be completed <br /> whether specilied herein or noL The r�ranting ol a pemut does nof presume to givo authonly fo <br /> violateo�cancelfhe prov�sionsolanyofhersfafoorlocallawregulafin�consWcGonorthe <br /> pedormance o/consfruchon. Thaf 1 am aulhonzed by the o�aner ol fhis pmperty fo pedorm tho <br /> work lor which applicafion is made and 1 comply wifh fho Sfafe Contractors Law 18.27 RC W and <br /> 296.200 WAC. <br /> ,�„"_ ���� �1 (�-{ c�5 <br /> Signature Dale <br /> �05 d9-�3 7 <br />