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ELECTRICAL PERMIT APPLIGATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR 5i REET, EVERETT, WA 98201 <br /> 475-257-8810 - FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ,�Z ��z��O'(' <br /> r �L `� <br /> j I 5����� 5� �vdre-fI vv.c�l �,�.�..1 �✓zrzTi wi=t �'1 �6� �-' D <br /> f <br /> PROJECT ADDR[SS <br /> Ownef hlail Address Cily State/Zip Phone <br /> �r, � <br /> �;��'�;'_ r1DS �l(o���� SSC:r'� ao� '�IS1�0 <br /> Tenanl Mail Address City State/Zip Phone <br /> \- �s�b- 33 �- �3 `!O <br /> L����1�� � 3f `G L�4�e�cnT i�i_v�(� Ft m;l� S�- ��f 7�`� <br /> ElecUical Conirac�or Mail Address Cily State/Zip Phone <br /> LC��6 �� ��% �'� <br /> ✓-� 1���v Zr1(� � �' C'i�lc�L1- <br /> Slale License Numbc-r Contract Price o(Work <br /> C f�5�Pl.V1�LtiY�� �' ��L1S � �bi�i� 1���-�'��� �✓(4ti'ISG ��� �j��i'� � `( ��j0 <br /> Proposed Use o(Building Contact Person (Plan Review) <br /> Descripfion of Work to Be Done: (.v���- � S ;��"!Q`r5 �U h�`-� C� T <br /> ��-��:t�� w �-��h C 17 �lD `�i�^.,({r d- �W�� <br /> /� 5 U�,� ,� S�.� s �-c � ��,�.. _' •,1 (-«� c <br /> � <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> � <br /> I�� CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certily ihat I have read and exarnined this application and know the same to be true and <br /> conect. All provisions o//aws and ordinances governmg fh�s lypa o/work will6e completed <br /> whefher specdied herein or noL The grantin.q ol a pernut does not resume to give autY,ority to <br /> violate or cancel the provisions o(any other state orlocal law reguPfing consWctio�or Ihe <br /> perfonnance o/consVuchon. That I am aufhorized by the owner olthis property to pe�rlorm Ihe <br /> �vork lor�vhich applic�lion is made and I comply with fhe Sfafe Contracfors Law 1R.27 RCW and <br /> 296.200 WAC. <br /> ,'1 � .. �; <br /> : �< -;�(' � ��../ <br /> Signaturc D'dte <br /> '— _ �'L�/ <br /> J � <br />