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ELECTRICAL PER�VIIT AP'PLICATIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETf, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —�wdw.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> _�C, � '✓ :1� �i.-'/. .' / /��%/��7 /f!(, _ <br /> PROJECT ADDRESS <br /> �j /' / ': <br /> �'\ �r?/i/,' L/ l , .'%i�:.-/� /�� U'O%i%✓�� /i:.C:.. <br /> Ownur � � Mail Address City State/Zip Phone <br /> ,f��i/%�/!?i� _�/t/C���� .�,7i�L �(jm��'7✓<7 /�/G. �l/Z/'c' � lil/� `l..�C�s'�,��,�'_ 7.�7.J <br /> Tenanl � M11ail Address Cily �/ State/Zip/ Phone <br /> . � . ,�O�o//-� ��?rnL%I/j�vere�� i y�'.�Ji ���� <br /> �/�ni�-��-�-�:n . �-�r� f/F'/� .Lr �'_- �o���// (.fif1' "�'r'z �/<�= 77C.,�. �O <br /> Eleclrical COnlracto� Mail Address City St3!e%Zip Phone <br /> ��ri fY7!'1���1 �.J i9 Q��c _ <br /> Stale License Number Contracl Price of Work <br /> l'�,�i>r fi79 e?✓1 � <br /> Proposed Use of Building Contact Pc;rson (Plan Review) <br /> Description of Work lo Be Done: �tJ��-�t= !/i-Cicd�ot OL�1"�T"-S � .�CC�i TC��c j.UCr--/e'�'� <br /> �_•_ . 7�f'l' /f^i./'� �JC7�, <br /> NOTF: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE RJ RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> �'�5 I �° <br /> 1 hereby cerlily that I have read and examined fhis application and know Ihe same fo Ge irua and Z - <br /> correcL AII provisions o/laws and ordinances goveming this type o/�rork will be complefed � <br /> whether specified herein or noL The c�rantin�oI a permit does net resume to give authorty to ( <br /> violate or cancel the provisions ol any other state or local 1�3�v raguPting construchon or the <br /> per(ormance o(consf�uction. That I am authonzed by the owner o/this property fo perfomt fhe <br /> �vork lor which applicafion is rnade and 1 comply with the Sfate Contraclors Law 18.27 RCW and <br /> 296.200 WAC. <br /> / . ;,J �i/ � �� _ '�' - � `�i <br /> i�.,,../c"."�✓''- -- 1 `-. /`��� ✓ �- <br /> Siynature Date <br />