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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.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> ��' Sc_� e Vc�"zC�— A9!J2C (.v�4-�.� <br /> PROJECT ADDRESS <br /> ..�, ,-� A; � <br /> . ' <br /> /�%.'+/<� E� �i ��l, 1. I� / .� � jC' C".')!'�,Z� i�!( 1)�' ��:..i-•,' _� d'v 'i - ".Y <br /> O�vner Mail Address Ciry SlalelZip Phone <br /> TE��xcr.� �ES - , o S�S EY�3�. N�t l ��ii}l� E7�"'�C-e� W%9- . %�'�4 3' <br /> Tenan� � Mail Address City SlatelZip Phone <br /> lbzi z Cs'�� �" lt� Fz3�i .�ic� c.er�', c�%F 5d"o�Z <br /> ��T S(C ti/ Sc�2✓<CC t os���-vt-� s�����'r,--,� S�� - <br /> Eleclricai Conlraclor Mail Address City � StalelZ�p Phone <br /> �� <br /> 13t3�5ts� �190PG� -� YS <br /> Stale License Number Conlracl Price of Work <br /> (<C 7)i 1( �/�?-�l-,-tll �p�n�/���� <br /> Proposed Use of Building Conlact Person (Plan Review) <br /> Descriplion of Work lo Be Done: �G� ( f� �/(�/✓ "Tb ��S���' /'�v�rL <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> � <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby certil}�that I have read and examined fhis npplicalion and kno�v the same to be frue and <br /> correcL All p!oviswns ollmvs and ordinances govemmg Ihis type oI work�vill be complefed <br /> wbefher spealied herein or not The�ranfinr�o(a pennrt does nof resume fo give aufhonty fo <br /> violafe or cancel lhe provisions ol any other sfafe or local la�v re�uPfing corsWcfion or the <br /> performm�ce o(const�uction. Thaf I am authorized by fhe o�vner o(this property to perform fhe <br /> work lor which applicafion is made and I comply wifh the Stafe Contracfo,s Law 18.27 RCW and <br /> 296.200 WAC. <br /> i <br /> /�1/ — <br /> !� i_�: � : <br /> Signa�uc Date ���G� � <br />