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ELEC�'RICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857-www.everett�va.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> ��(�'I/i/G'L'��L �-(��/�'IlJ'/L�' �/.'C,'=Ci% <br /> �� �� ��--�����>t�i��� /7(i�f� <br /> 0 <br /> PROJECT ADDRESS <br /> /r�'ir/3.V1/t.'_ r.UY/T-L/;,(,, <br /> ��r d,2Grr <br /> ���_/ ZS �-�L�/>h/f,�OiJGc f--dC,�'t�i Lt,r�- <br /> Ownef Mail Address Cily State2ip Phone <br /> /Nl M�n,'�"..r� <br /> L�rHE2N 2 �zl LGf9/SA�iI� �t4=��_"�T l ./� <br /> Tenant Mail Address City Slate/Zip Phone <br /> �r Y��� i «�/�T/l✓c �J�C� <br /> c C� , �rlc- S (JD /-"i�s : :�-/r�rr✓ M(i,U/'rE Gv'�� I5�7Z ����s- 7��'�� <br /> Electrical ConUactor Mail Address Ciry Slate/zip Pnone <br /> L�—J��G��,1 ���� 7� S �G s,� C ! <br /> State License Number Contract Price of Work <br /> � :/G ,�- C. ./7� �_'!� /�!1/�%�%;��� <br /> Proposed Use of Building Conlact Person (Plan Review) <br /> Descriplion of Work to Be Done: /if�S i������-- !`t�� `�i�C_ ( � / � ��+���:�Gf//�-/ 5 <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> i <br /> t <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> � I hereby certily Ihat I have read and examined this application and know the same fo be true and <br /> correct. All provisions o(la�vs and ordinances governing this type o/work�vill be completed <br /> �vhether specilied herein or noL The granting of a Permd does not presume fo give aidhonty to <br /> violate or cancel the provisions of any other stale or local/a�ti�regulafing construction or the <br /> peAonnance ol construcfion. That I am authoiized by the owner o(Ihis propeRy to peAorm the <br /> work lor�vhich application is made and 1 comply�vith the Sfafe Contractors Law 1827 RCW and <br /> 296.200 WAC. <br /> � _ <br /> :4'?�-t)C�`.�'�;'/�/�[�11Yk4.-�. (/�/ // •'7� � _ <br /> SignaWre 'y�—� �- 3 ate <br /> J ���' �� �� _� <br />