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-� _ . <br /> ELECTRIGAL PERMIT APPLICATION <br /> CITY OF EV�RETT PERMIT SERVICES <br /> 3200 CEDAR S�i?EET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> %d"..23 C.o� �3tElt? <br /> PROJECT ADDRESS �5"� <br /> 3l'�� <br /> NO�.i� �2?r�"!]'A' c�S�bR.I�(Fi l�Z� Lo.��s�lU� � FUG�Gt,€n �ld��/ <br /> � <br /> Ownef Mail Address City Slate2ip Phone <br /> Tenant Mail Address City Stale/Zip Phone <br /> �r��-.uiU/�f�lZ s x S 3<a� �z /'/f�l k� � (�,��� 9f� ( 2�g� � <br /> ElectnCal Contractor Mail Address City State2ip Phone <br /> �Yc��vssiy�. LP <br /> State License Number Contract Price of Work <br /> S r-�, <br /> Proposed Use of Building Contact Person (Plan Review) <br /> Description of Work to Be Done: ��/4/�,�(a� /—U�F �3�0'C�G � �.0 ✓�/1!� �'�GT�� L <br /> Y' /1'LD U,E �1-fl�c �t . G u7'Sf V� <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. aD <br /> s-s - <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby ceRi(y that 1 have read and examined this application and know the same to be true and <br /> conect. Al/provisions of/aws and ordinances governing this type of work will be completed <br /> whether specified herein or noL The granting o(a permrt does not presume to give authonty to <br /> violate or cancel the p�ovisions o(any other state or/ocal/aw regu/ating construction or the <br /> perfo�mance of construcLon. That/am authorized 6y the owner o(thw property to pedorm the <br /> work for which application is made and I comp/y with the State Contractors Law 18.27 RCW and <br /> 296.200 W C. <br /> , ���- y/� �- <br /> Signa:ure Dale <br /> �� �� Ci" ��- <br />