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ELECTRICAL PERIVIIT 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 /> IC�c�` :�_ (_✓:�c-Y�� Ilno.� � �,�«�� 1��6�y � Sdc -a��IV <br /> L"v c.i c1l- V� i� �1� Z'`�`.� <br /> PROJECT ADDRESS <br /> I� �vc.e�" /L1c�11 �J�_.,� <br /> � �`-� Ui'1��lc.r� �1-� loc`�� Sc E Evcie"� 'v-�/1 `l`6�-og ��/� <br /> Ovmer Mail Address City StatelZip Fnone <br /> /JOO �SC C'.vCiQJ�- ✓LIAU llJCiiv, <br /> L � � �., �� �I✓C�S ��-�. `��o� z - S-reU/u C—���e� ��n �'�z.o$ N/fa <br /> Tenant Mail Addmss City SlatelZip Phone <br /> -{� n �/ �2u��. <br /> I'VID.C"Ui�CG.I(� Vti��1�/ 1717 �-C"1-iij�- ,lW SL..) ���1 \ `-( W,1 ��10�17�. �bu '��70 <br /> Elec�rica'Conlrador Mail Address City SlatelLip Phone <br /> �ti\��c �cyy�� ��z r; � 5� `r � � — <br /> State License Number Contrac:Price of Work <br /> C' ( �n� �v.�..�n��t>h <br /> _Cj Y h it—�.�( 1 L C L,A - <br /> Proposed Use of Building Contact PeSson (Plan Review) <br /> (7_UG/ '7(n�' �li�Z <br /> Descriplion o(Wark to Be Done: �� U( c��-c � -� —S �<�� �`^c� �L� d� � rLE�� <br /> � <br /> '�' —z �� �- <br /> --. <br /> G`� � <br /> NOTE: WIRING IN NON-DVVELLINGS IS REQUIRED TO FE[ <br /> BE IN RACEWAYS, MC OR AC CA6LE. <br /> 'I II CITY OF EVEP.ETT LOCAL SALES TAX CODE IS 3105 <br /> ' ;hereby certily that I have reao and examined fhis app!icafion and kno�v fhe same to be true and <br /> conecL All provisions o/laws and ordinances governing fhis typc o/work�vi0 ba complefed <br /> whefher spea6ed herein ornot The 9ranting o/a penmt does nof presurne to give authonty fo <br /> violate or cancel fhe provisions oI any other stafe or local law re5ulating construchon or the <br /> peAormance oI conshuchon. That 1 am aufhorized by fhe avner o/this property to peAorm fhe <br /> work Por which applicafion is mado and I comp/y wifh the Stale Contractors Law 18.2I RCW and <br /> � 296.200 WAC. <br /> � � � <br /> �c:�.���\, �. `--�_ 5 - /C� ' u � <br /> _---�Sigliaw«� -` Date <br /> ��� <br />