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ELECTRf(�AL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAFt STREET, E\/ERETf, WA 98201 <br /> 425-257-8810 - f=AX 425-257-8857 —www.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> �� � � ��.� h, ��� <br /> PROJECT ADDRESS <br /> / , � ; l� �� n 1�.� r �5-�-w--� <br /> Ownei Mail Address Gty Stale/Zip Phone <br /> Tenant Mail Address City Slate/Zip Phone <br /> �� � ������" '`�- ��� k�G.�'.S � .a.v`�t,"� �,� ��'�-�' I <br /> k�l�c�l Conlraclor Mail Adtlress City SIaIG/Zip �- ;' Ph�@` <br /> � 'j' -r <br /> �/� <br /> 1 . t � . �,. � �� � � •��r �� ��.� .�- <br /> � � i � <br /> Stalo L c nse Number �ontract Price of Work <br /> Proposed Use of Building Conta It Pe on (Plan Review) <br /> Description of Work to Dc Dono: �� '�l v `� �-- � �.�_/ I ��� �-- <br /> I <br /> I NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> Cli Y O'r EVERETT LOCAL SALES TAX CODE IS 3105 <br /> J hereby ceRi(y tHaf 1 have read or�d exnmined fhis applica.ion and kno�•�Ihe same to be truu and / � / <br /> correcL All provisions of la�vs and ordinances governing Ous fype of uork�ti�ill be complefed � <br /> �vhelher specif�^d herein or noL The granting of a pernu:does nof �resume fo give authonty to , �� ` <br /> violateorcancellhe provisionsofanyofherstateorlocal/a�vregulafingconsWcfionorfhe <br /> performance o/construction. That 1 am authonzed 6y the oo�ner ol this properiy to perfonn the <br /> work/or which applicafion is mado and 1 cornply�vith tho Stafe ConGacfors Law 18.27 RCW and <br /> 296,200 NAC. <br /> i _----- � --, , Y�— �, "' /'� <br /> % i > ` � <br /> SlgnaWre Dato ' <br />