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I--- -- — -- -------I <br /> ELECTRICAL PERMiT APPLIClaTION <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 �' 'j G-.��Mr31�lZD /�Vl� <br /> PROJECT A�DRESS <br /> �7tNA� I�' i_ ri_._�/i t�i J�J 1;�L•Eh I��aJ ' S/fi .� Y=S Z3� -701c10 <br /> Cit StatelZip Phone <br /> Ownef Mail Address Y <br /> Tenanl Mail Address <br /> Cily StatelZip Phone <br /> sr-J���,— Sr` �v +�'r� 9° j� 5'2s z�.Z-y�`17 <br /> »i� " <br /> ��'/ti-�I '��L-�=GTI;f l. CO 1 G! . Phone <br /> Electrical Con ractor <br /> Mail Address Ciry StatelZip <br /> /� �< <= ��"� �' L C� �N � Ccntract Price of Work <br /> Slale License Number <br /> sth Contact Person (Plan Review) <br /> Proposed Use of Building <br /> yS ��. <br /> Square Foolage (ff residenUal new conslruction,remodel or addilion) <br /> Description of Work to Be Done: /��GL�11 or' � �=^XS i � �N�n �`� � �� I <br /> _ _- I <br /> � <br /> � NOTE: WIRING IN NON-D�/VELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. �� C C� <br /> � CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certily th�t 1 have read and eeamined fhis applir,ation and kno�v the sarne to be We and <br /> conecL All p�ovisions o(laws and ordmances goveming fhis type op(work w�ll be completed / � �j�, .`� _ l � C� <br /> � v o�/ate or car cel�he prov slons ol a�iy ofher�9tat aor loca�w regulat ig consfn9ict/on�or�t�ey to � <br /> � IpeAonnance�(consWchon. That 1 am aufhonzed by the owner of this property tu per(orm the <br /> �voric lor which applicalion rs made and 1 comply�vifh the Sfate Contrac(ors Law 18.27 RCW and <br /> I 296.200 WAC. <br /> � � - / 5-i_3 <br /> � � Date <br /> I � S!gnature — <br /> ,. <br /> I .. _ . . _ . . ._ .. . _ - --- ----- <br />