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i <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200�:EDAR STREET, EVERETT,WA 96201 <br /> 425-257-8810 - FAX 425-257-8857—www.evereriwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> `�$15 �'�U�Iclre_ �cl��e <br /> PROJECT ADDRESS <br /> I <br /> �Q.meS � ���1�u� -;c�-u--l� �1`bi5 llelawnrd �Ah� Verell9Rw�s �2`�-7�-�,11R <br /> OYmer Mail Address Ciry StalefZip Phane <br /> Tenanl MailAddress City Stale/Zip Phono <br /> � <br /> - q ' � � �ii 9 � . � - �hs <br /> =iedrical Contredor ail Atldiess C0y State2lp Phone <br /> '`t,�`�xr�ct I�--1 IzS �5C11�� <br /> Stale License Number Contract Price af Work <br /> Proposed Use o(Building Contad Person (Plan Review) <br /> Descriplion of Work to Be Done: �e -�� � `, � l�Yl�l ` D � h�-Y�P ��,�� <br /> � <br /> -I i <br /> �,.U�L. (1l ^o t ' 1'�T <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FE�� <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAl(CODE IS 3105 <br /> 1 he/eby certily fhat I have read and axamined this npplication and know the same to be true and � �,��(,�-(��Z <br /> correcf. All provisions o/laws and ordinances govemmq fhis type ol work will be complefed <br /> whether speci/ied herein or noL The granfing ol a permd does nof presume to give authorfly to <br /> violate or cancel fhe provisions oI any ofher stafe orlocal law regulefing oonstruchon or fhe <br /> peAormance ol conslrudion. Thaf 1 am a�thorized 6y the owner ol fhis property fo per/orm the <br /> work Ior which appGcation is made and I comply with the Stato Confractors Law 1827 RCW and <br /> 296.200 WAC. <br /> � I,, � � c1_ - <br /> � �'I 1'�l,C �i L� -�1.� ,�G'Y �l � �� <br /> Signatum Date <br />