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r i <br /> I <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SEkVICES <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 Ph1 - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> '�l� ��: (—v�r�ti- Mall I�� STZ= Evere-+4 ,c,�, a��2� <br /> PROJECT ADDRESS <br /> �'Ok'f�ll�v�kc�� ICp���: C�z°rc-� �-�ct�l �`c.�u� 2� ��'zf-f" ��' �f��� <br /> Owner Mail Address City State2ip Phone <br /> �f>I�u=r�l �,�kc.r 10�0 ��C� Cu-V--F(au u`ct��s7� 2cx� E�t.�ti (s� �R 2�)� <br /> Tenant Mail Address City Slate/Zip Phone <br /> L�vv)�a3 .. <br /> �I � 1 .fL�� ir� c� I�t��� Fir� A�x ��E. ,�«i f le l�',� (�12`�° �a�+J <br /> Electrical Contra or Mail Address City Stale2ip Phone <br /> (,Ll�rc��F i lqc � � �P ��,�0� <br /> State License Num6er ' Contract Price of Work <br /> P�C-;cs� — <br /> Proposed Use of Building Contact Person (Plan Review) <br /> Description of Work to Be Done: P���11C _ �d �l.l�.\ <br /> NOTE: WIRING IPJ NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IPJ RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERE7"I'LOCAL SALES TAX CODE IS 3105 <br /> I here6y certify that 1 have read and examined this application and kno�v the same to be true and <br /> correct A/l provisions o//aws and ordinances govemmg this rype o(work will be completed <br /> �vhether speci(ed herein or not. The gran�ing of a parmit does not presume to give authonty to <br /> violate or cancel the provisions of any other state or/ocal law regulafing construction or the <br /> peAormance of construction. That I am authonzed by the owner o(th�s property to pedorm the <br /> �verk(or which application is made and/comply wdh the State Contracrors Lsw 18.27 RCW and <br /> 296.200 WAC. <br /> � <br /> ���1;�JY.�,, n`c� ���.� �� �� d�-( <br /> SignaWre �ate <br /> �� 4/67 � I �l <br />