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i <br /> ELECTRICAL PERMIT APPLICA,1'ION <br /> CITY OF EVERET� PERMIT SERVICES , _, ; <br /> 3200 CEDAR STREET, EVERETT, WA 98201 ��J ''" <br /> 425-257-8810 - FAX 425-257-8857 —www.everettw�.org <br /> APPLICATIONS ARE AC:tEPTED FROM 8 AM TO 4 PM /Z- 3 p—O y <br /> C GY( z-� 2 �� <br /> Iv1U Fvrurr ��1���� I�I�'�4 S�'llc.;= �u� <br /> PROJECT ADDRECS <br /> 1�-6 a-�,T�ic_ l u i o E,,,�,�,�c�� n�n�� i_;�+�� F,,�r..F��fi t,.�a <br /> Owner Mail Address City Slale2ip Phone <br /> ��fLo 1 E I� <br /> Tenant Mail Address City StatelZip Phone <br /> �j"J_�r iti��ur✓}..�/i<<4r q�3u ����� /��aYiUF_ ��w��,,.r. wbl 9X��Z �4Z'��SX3�°�zz� <br /> EleCl�iCal COnlraciof Mail Address City StatelZip Phone <br /> ���2,r v�i �l si N�S � y� `u <br /> Stale License fJuntber Conlracl Price of Worh <br /> �N't,��L(,.i:L <br /> Proposed Use of Building Contact Person (Pla� Review) <br /> i <br /> Descrip�ion of Work to Be G�one: .�-DC.�4 1`r 3 T� STl4 i S <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> 4 BE IN RACEWAYS, MC OR AC CABLE. <br /> _J <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby certily(haf 1 have read and examined fhis applica6on and kno�v fhe same lo be true and <br /> correcL All provisions ollaws and ordinances governing!his fype oI work will Ge completed <br /> whether specilied herein or noL The granfir,g ol a perrr,d does not presume to give aufhonty to <br /> violate or cancel lhe provisions o�any other sfate or local law regulating consfruchon or the <br /> pe;formance o/construcfion. That I am aulhorized by the owner ol this property fo perform the <br /> work lor which applicafion is made and 1 comply wlfh Ihe S(afe Contractors Law 18.27 RCN�and <br /> 7.96.200 WAC. <br /> ��_� `� ��,��yo\� _ <br /> Signature � L'ate <br /> �ojr3� t �S <br />