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�.- - - <br /> � <br /> ELECTRICAL PERMIT APPLICA�'I�N <br /> CITY O� EVFRETT PERMiT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 -www.everethva.org y a 6-0 8 <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM L��� '�f"I� � <br /> I D�10`� ��c,L.1�� I�a • ��, ; n .�r r_ <br /> PROJECT ADDRESS <br /> �i)�=,J�� <c>�ti��R� ��'��•S; �� � ��7i�rsVil/� �IIA �tf��r� <br /> Owner Mail Address Cily State/Zip Phone <br /> Tenant hlail Address City StatelZip Phone <br /> yc �JiUIZ� ��� cl'aIC I�U` 1�0� � v2Z �`"�7R�bVi/lE �l�!/� �s5'2Yd �uz�� �?a-13�/� <br /> EleclriCal Contreclor Mail Address City Slate/Lp Phone <br /> �GU7U�� C(C1�i3lj' <br /> State License Number Conlract Price of Work <br /> � rv���Cr j�'�41-t. lJwcll �F�( '� <br /> Proposed Use of Building Contacl Person (Plan Review) . <br /> DescriptionofWorktoBeDone: ��`L�,�k%� �'���Ji< '� �'S�l/17/ �('��'U SCJ � t' <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> I <br /> CITY OF EV[RE iT LOCAL SALES TAX CODE IS 3105 <br /> !hereby certily thaf I have read and examined fhis applica6on and kno�v the same to be frue and <br /> correcf. All provisions ollaws and ordinances govermng fhis lype o/wod<aill be complefeA <br /> whefher specdied herein or nol. The�ranting o/a pernuf does nof resunte to give aufhonty to <br /> violete or cancel the provisions ol any other state or local law reguPting construchon or the <br /> perfonnance oI construclion. That I am authorized by the owner el fhis property tu peilorrn:he <br /> worh lor�shrch application is madc•and I comply with the Slate Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> -�_...__._.--.,; <br /> � r <br /> -�—� � � . , ) <br /> ��.�:--=--; .. _ G�i°- � C - ZC�C �D _ /C�� <br /> . Signature Dale � <br /> i . _. _ _ .____ _. _ . . __ __._-_-_— ___ _—. <br /> i . . <br /> e'^' .., `} �,`T + ... <br /> �.9K'Y L�TT''A'�' .R` a�"Si�y. <br /> 'C{\ <br />