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; ��t- �.� ��-� �Z � � 1. �� , �j E�C; � ti.,E^•, � <br />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 />�L�� Z 5� t:.Ur �-e t1 l+'lal( W�n � $.., ��, �� � OJ �{�Cd iq �c� �o�ti� q- <br />� ��g, ��-rj'-�4�ff—.bd - <br />PR EC�l �ADURESS �`----- <br />� �F* i2�l�'h�� 1�10Z -�� f-1e✓rtf-/^1�llw,� �uE,^eif,Glji �18ZU$ (ycs),�s.i=/� <br />Ownef MailAddress Cily Slatz/Zip Phone <br />S�w/�e�,rer{'o��ls u�ynf ��' 1375! #f�/�OGtiGrcr�'� <br />� O� �DQ <e��j(�le�wf� fRI25 �2oN)3oo-�ll3s <br />Mail AdUress <br />Address <br />�32Sc;/i�� 9���� <br />Stale License Number <br />Proposed Use <br />58 <br />City <br />SlatelZip <br />✓e✓'Nt}", W!4 � � 2 I 3 <br />Sta1elZip <br />3oU ^� <br />Conlract Price of Work <br />Contact Person (Plan Rewew) <br />Description ot Work to Be Done. � J�� E t" �l C-n�i i� 5�«, f � ���.ti i h S Jc: �.�, � �oCrvl <br />NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO <br />BE IN RACEWAYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I 1 hereby certi/y fhaf I have read and examined this applica6on and know tlro same fo be frue and <br />'� correcL All p�ovisions o/ laws and ordina.�ces govemmg this type ol �. o�k will be complefetl <br />� whether specilied herein or not Tha g�anfing ol a pennrt does not 2sume to give avthorily fo <br />lviolate or cancel the provisions o/any other stafe or local law reguP6ng construcfion or ff�e <br />i pedoimarce oI consfrucfion. That I am authorized by the owner o(fhis property fo peAorm fhe <br />, work lor which applicafion is made and 1 comply wifh the Sfafe ConVacfors Law 78.2' RCW and <br />� 296200 WAC. <br />i <br />S `-'�`7 -1 —�/ � ��i � -' � <br />I' SignaWre :! Date <br />FEE <br />� ����� �Z�� <br />Phone <br />1 z - z �15L> <br />Phone <br />7/ <br />