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ELE:CTRICAL PERMIT APP�ICATION <br /> CITY OF EVERETT R�RMIT aERVI ,r,ES <br /> 3200 CEDAR STREE:T, FVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8057 —www.e�erettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> /LC� i� lo '—is�„L i �'�/4� <br /> PROJECT ADDRESS <br /> '�� -} c{ Cyf/C77 EVt/r{f W� I�Z� � _ <br /> Owner Mail Address City State2�p Phone <br /> ���at �✓a�c � S�;l�f�� /?�S �:,�fsr-K � l✓r' �vP�P l�/�+ 5h�1 <br /> Tenanl Mail Address C�ty State/Z�p Phane <br /> �Z S <br /> � � �s� . <br /> ��[�� ^�f �f� �r' ���c ?', 7� � l� a�/ j.<<��v'� S�"C�: Fv Pi� �� /c`�zC�S �f c 7 <br /> �tlecl�icalConlracto� ��1a�tAddress Ciry SlateiZ�p Phone <br /> i�/'�LE �E97`� �"� ���°' `�-�-- <br /> State License Number Contrect Price of Work <br /> � >'�r��Y/ a' �'�%c- <br /> Proposed Us of Building Contacl Person (Pian Review) <br /> Square Footage(If residential new construction,remodel or addition) <br /> L -J �-i a o� Y,�--'rr---�--rm-�` �";,,,;�' <br />-. <br /> Descriplion ol Work to Ba Done: 1�i nu!���T S f.� z�z <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. I � �S o <br /> i b <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hareby ceRi(y thaf 1 fiavo read and examined fhis applicafion and kno�i the sama to be fn�e ond � 1 ZO� _ �/� <br /> conect. All provis�ons ollavrs and ordinances govemmg this fypo ol wark wdl bo completed l V <br /> whefher speci�ed herein or noL Tho granfing ol a permd does not p�esumo to givo authonry fo <br /> violafe or cnr.cel(fie provisions ol any other stato or local law regWating consLvction or tfie <br /> pedomiance ol conslruofion. That 1 am authonzed by the owner o/fh�sp roperty to perform fhe <br /> work lor which application is mado and 1 compty wifh fbo Sfofe Confrac(ors Law 18.27 RCW and <br /> 296.200 WAC. <br /> �', <br /> / � ,���- �i�b��Z <br /> Signatura �ato <br />