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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.evereltwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> IiI ��c � rf <br /> PROJECT ADDRESS <br /> -l� � ).< /�'rd�-LL � 101 Lc ���u• /��•.�u E���,�r.�x Cu.i �'jP'7-�5 NLr-�17- 7L13 <br /> /";/� <br /> Ov:ner Atail Address Citp State;Zip Phone <br /> Ten.cil �dail Address Ci�y Siatc Zip Phone <br /> p ti,r"� ,�, /J6�vt- <br /> [ledrir.al Contraclor Otail Address • City State/Zip P��e�" <br /> Slate License Num6er Contract Price of Work <br /> Proposed Use oi Buildinr� Conlacl Person (Plan Revie�ti� <br /> Desc�iplionofWorklo�eLone: /`�'., r �. jy: �� •) i.,.�J�_� c - - � i.�- 4:: �Jljtr. ����' < 1.1�.��i.^ <br /> / <br /> C � 1f�� G �rr F)rt Sutv��� 1 _ <br /> �OTE: WIRING IN NON-DWELLINGS IS REQUIRED'TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SA!.ES TAX CODE IS 3105 �I/„�Z_��� <br /> 1 hereby certify fhat I have read and examined Uiis applicafion and kno�r the samr, to be true and L"�+L��J <br /> correcl. All provisions o(la�vs and ordinances govemm�(his type of�rork �rill be comp/eted <br /> whefher spea(ieAherein or noL The granfing o/a pemut does naf resume fo give authnnty fo <br /> violafe or cancel fhe provisicns of any other sfafo or local lau�rec�uPfing consfn�c6on or fho <br /> peifomiance of const�uclion. That I arn autho�ized by fhe owner o(this property to perfurtn the <br /> �rork for�vhich application is made and l comply�vifh the Sfate Con(ractors La�v 18.27 RCW and <br /> 296.200 WAC. <br /> ' i� � � :_� :�� • ) �pt� <br /> Sic�nalure ale <br /> I------------------ ------- <br />