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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMiT S�RVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 /� -a�-o 6 <br /> 425-257-8810 - FAX 425-257-8857 —H�ww.everettwa.org �D(�I! --/� Z <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> �, 5 ; � Cj,�,, � �� � J -t <br /> ,- _ � _ 1-- � -�_: <br /> ...�: ��' -.-- �"��-��-->-_ <br /> PROJECT�;DDRESS <br /> � ,� yL>" > S <br /> � ,; ;�:;,-r� S/;...j1f , ,.i �`���Y� 8�,.�� .51 �✓ir��/ iG %� '7�zc3 ;a.yz <br /> Ownef Mail Address City State2ip Phone <br /> Tenant Mail Address � � l:7ty � Slale/Zip Phone <br /> .�l C I �'!,'Y�f. �c � `/z S 'z> >_ <br /> ' � �l�`- �' ,9 yS ��� <br /> i/p[/ Zr �. %rs }� �!'i�'�iir �� �'//f-�l- / 1G / <br /> El�ctrical Conlraclor Mail Address Cily State/Zip Phone <br /> � ��,a�.�.ss ��i�� � P i��-�- � <br /> Slale License Number Contract Price of Work <br /> � <br /> �) �'S <br /> Proposed Use oi Building Conlacl Person (Plan Review) <br /> Description of Work to Be Done: ��"�r c 'f � ;;i-/7 a c � }� / 5 y'� � <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIREDTO FEE <br /> BE IN R,4CEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby certily fhal l have read and examined fhis applicafion and know the same fo be Wo and � �J Z- <br /> comect All provisions ol la�vs and ordinances govemmg this rype ol work u�ill6e complated �GW�� <br /> �vhether speci(�ed herein or not The�ranfing ol a permif does not resume fo give aufhonry fo <br /> violafe or cancel fhe provisions oI any ofher state or focal law reguPting consVuclion or fhe <br /> perfomiance o(construction. That 1 am authonzed by Ihe owner o(this property to perfomi fhe <br /> work lor which application is ntade and 1 compty wifh the Stafe Centractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> , : � <br /> , . � • -c <.j � ` <br /> � � L C /��':' / - 7' �� <br /> Sigoature Dale <br />