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r -- <br /> `� <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <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 <br /> /�i/%D �/�c f�s S��«T <br /> PROJECT ADDRESS <br /> y2S3VV48 L <br /> _��Nfo,J /-2�o��� ,a �% llZl'I 3`i�� � � 5�= �Vt�l2c'rT wl�! 98�ey <br /> OwnCr h7ail Addross Cily State/Zip Phone <br /> (�Z�etit•� I'jvti'.lcan� (t21�1 3�i`��' DK SC EU��.E'tT �J7f `�'�2ofr' �(LS'— 34�( �(�C 1 Z <br /> Tenanl Mail Address City Slale/Zip Phone <br /> Gkha �"1��(oAa ��Z11 3`i��(l5E F(Jc.1LtTT U.1 ��- `j�Zi1� 1�2.5`34y ��i7Z <br /> EleclriCal Conlraclor Atail Address City Slate2ip Phone <br /> Stale Lice�se Number Conlracl Pnce of Work <br /> Proposed Use of Building Contacl Person (Plan Review) <br /> Description of Work to Be Done: _ �w1(� �11_tJ� �'c* <br /> NOTE: WIRING IN NON-DWELLINGS iS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CAl3LE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby ccriily thaf 1 f�ave read nnd exarnined this application and kno�r fhe sn�rie to be frue and �L-�pt�—�'7lG <br /> correcL All provisions ollaws and ordinances govemmg this type ol work will be complefed <br /> whefher specified herein or not The granting oI a pernut does nof resume tu gi��e aidhonty to <br /> violafe or cancel fhe pmvisions olany other sMfe or locallaw re�uPting construction or fhe <br /> perfomiance o/constnrction. That I arn aufhonzed b}�the owner o/fhis properly fo pedomi the <br /> �vork for which applica(ion is mado and 1 comply wifh fhe State Confractors Lo�v 18.27 RCW and <br /> 296.200 WAC. <br /> � <br /> i <br /> � ��� , ����-� ,�._ s/� � � <br /> Signalure j% �ale <br /> 1 <br />