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� <br /> � �G���� �n � C�a-t-�-- s� � e�c�c;� P�.,�-�--#� <br /> . <br /> 2' <br /> �- ` U <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICE:3 <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-z57-9810 - FAX 425-257-8857-www.everethva.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> I �� � I_Da�����-rd �-tu�e, �l—��-r U <br /> �iyo �i�o�b <br /> PROJECT ADDRESS <br /> �/�S- <br /> t� z��- <br /> PV t� y�.�. ���e� I D 1 L-c�m�� �; �P/e� Gt1�r -'�1?32t�1 , v�8 <br /> OWnCf MaAAtldress � Jy StatlLip � Phone <br /> r <br /> TCn3nS � /�i� 1Aa�Addreys C�ty :italc;2ip Y Phone <br /> �ass�z <br /> �-£u'�er ��cf�c.�SeP�l�c"� Le�, 13�i rJ�l�`5f. !�, UJh `��S l7� i <br /> EIeClriCalContTactpr � ASailAtldrC.S � Cly . StatJZjp Phone <br /> �-+�� E�S G� � P� ��a5 '_ <br /> Stat� Lict3nso Number � ConVad Pnco of Work <br /> S �� � �1�xE—P�'-�-�-( <br /> Proposed Usu o(Building Contacl Person (Plan Review� <br /> Description of Work to Be Dona: �,I_...l��l� '��5�� 1 '" �� <br /> NOTE: WIRING IN NON-DWGLLINGS IS REQUIRED 70 FEE <br /> QE IN RAC[WAYS. MC OR AC CABLE. �C3Q <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 910G 1 ' � / �-q/ <br /> I hoioby cortrfy flrat I havo ioad and oxaminnd fhis applicnHon nnd know!he S,me to be hue and G I LL�11--V //� <br /> correct. All provisions of/aws and oNinancos govommg this typo of work will be cvmpletad �� t l bl� <br /> whofher spocrfiod hom�n oi not. 7ht+9renlinr�o/A parmR does nof resume!0 9ive outhenty to <br /> v/oloto orconcel Uie provislons o/nnyotAe�s(ate orlecallawreguPGng consWchon orfho <br /> peNormnnce o/consWcNon. That I am authonzed byfho ownorollhis p�opeRy to pedorm fhe <br /> work lor which�appficaGon is mede end I romply wifh tha Sfate Contrdcto�Law 18.27 RCW anU <br /> 298.200 WAC. <br /> �2��r��°�- �t���� � - 1� - I� ' <br /> SipnoWre �— D�to ' <br /> h <br /> � <br /> TO/i0 39dd �Ib1�3�3 �3aNti� 998ZL95SLb Bb�LT hi0�/�T/h0 <br />