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lZ - 13 -O� <br /> � <br /> ELECTRIC�I� PERMIY APPLICA�'ION <br /> CITY OF EVEf2ETT PERMIT SERVICES <br /> 3200 CEDAFZ 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 - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br /> ( o :' I S� tvt(�err Mti�� �ti�h� �� N �� A <br /> PROJECT ADDRESS <br /> ��( h;v�l ��, � i ��1 "�,,ii� I�' � :',`,, � , � �� 1 :�,� :.I'_� tf� �,(I��'ci t,���/, �1;=�,''�;f_ <br /> Owne� Mail Address City StatelZip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> I�:G�scrl l:tecPl� I��-IC ��e �F'��,�� �,-c ; l,i\kE Si�vCr�1�� ���;�i `i52S'� yzS -��'/57��5 <br /> Electrical Contraclor Mail Address Ciry State2ip Phone <br /> (���;•�C 1-1[,I-�i�i 3C1'1- <br /> Slate License Number CoNract Price of bVork <br /> ���-�� <br /> Proposed Use of Building Contact Person (Plan Review) <br /> Descriplion of Work to Be Done: . ��'� f���'�� �C I����-�� <br /> NOTE: WIRING IN NON-DWELLINGS IS REC2UIRED TO FEE <br /> BE IN RACEWAYS, h1C OR AC CABLE. _- .— <br /> ���� _ <br /> ICITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ce�ti(y(hat 1 have read and ea�amined fhis application and know fhe same to be true and <br /> correcL All provisrons ollaws and ordinances goveming this type o(work will be comp.'eted <br /> whether specdied herein or not The�ranting o/a pernut does not presume to qive aidhorify to <br /> violate or cancel the provisions of any ofher state or/ocal law regulating construcfion or the <br /> pedonnance ot construction. That 1 am aufhorized by the owner o(this property to perfomi Uie <br /> work lor which applicatron is made and 1 compty with Ihe Stafe Contractors La�v 78.27 RCW and <br /> 296.2U0 WAC. <br /> �X�-- ;C J �,� i3 _(; �-- <br /> SignaWre�' Dale <br /> , y_i �71 �- �:�(' � <br /> � <br />