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( <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 4'L5-257-8810 - FAX425-257-8857 —www.everettwa.org g`15_�,� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM E.�a.p�—D�� <br /> 1=t z�� o,�,,�ar� ��� <br /> PROJECT ADDRESS <br /> L u,, n�sc ,., /V �str�-� �9.�� ����,���/��✓e � ,� ,/� 9��G l <br /> Ownef PAail Address Cily Slate/Zip ��� ��n��� <br /> Tenant Mail Address � City Stale/Zip Phone <br /> � � � .. . ;� 3 �� Jq� �—�� s,—�N� �,c r�—�/���� <br /> Elect�ic I Conlracto� Mail Address / �ity Slate/Zip Phone <br /> LI�-� Y C�l y�GL�i � _ ��� a� �� <br /> Slale License Number �ntract Price of Work <br /> Proposed Use of Building Contact Person (Plan Review) <br /> Square Footage (If residential new construction,remodel or addilion) <br /> / / <br /> Description of Work to Be�one: / � � <br /> � o � - � u �- a�e ra � , <br /> �1�i..� [� �J'C�.�-� ` CL✓ C�Ar�t �-C z ' On> <br /> NOTE: WIRING IN IJON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LCICAL SALES TAX CODE IS 3105 <br /> I hereby ce�ti(y that 1 have read and examined this applicatipn and know the same fo be true and f � Zl� - v�'� <br /> correct. All provisions gf laws and ordinances goveming this type o!work will be completed l.i <br /> whetherspeci�ed herern ornot. The granting o!a permit does not�resume to give authonfy to <br /> violate orcancel the provisions of any o(herstate orlocallaw regulating consfruction or the <br /> perfonnance ol construction. That 1 am aulhorized by rhe ownero(thisproperty to peAorm fhe <br /> work(or which applicalion is made and I comply wifh the State Contractor Law 18.27 RCW and <br /> 296.200 WAC. (� <br /> \\ <br /> � �� � <br /> i'� �'lt!-l-+' .� � <br /> �Signature Date <br />