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G <br /> ELECTRICAL P'ERMIT AP�LICATION <br /> CITY OF EVERE �TT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 9a201 <br /> 425-257-8810 - FAX 425-257-8857—www.Everettwa.org <br /> APPLiCD�TIONS ARE ACCtPTED FROM 8 AM TO 4 PM - DEBIY & CREDIT CARDS ARE NOT ACCEPTED <br /> � � ���- - (�o�-�-- - <br /> PROJECT ADDRESS <br /> ^ U..Q�L2 - ��.3`�C1 '����� <br /> �o c�c;-f� t,v�� — (b"L�-- 1�-(0���- �C � <br /> Ovrner MailAddress Cily S�atelZip Phone <br /> Tenant dail Address Ciry State/Zip Phnno <br /> , A.K.A. E��f,;z c:� 1.�� � '�-0�3 �7-�tL l�; �.C- y.o ho��sli� l,� �� �: g Z� t� - _ <br /> � � � Eleclrical CoNraclo� Mail Adoress City StatelZip Phone <br /> cX� <br /> Ai� F���S�� �,P `2,po — <br /> State License Number Coniracl Price of Work <br /> �,,nt�l_✓ ��v�.�.lti.� Ze.S.lc��e.< <br /> Proposed Use of 6uilding Conla�t Person (Pla�Review) <br /> ������ ���> .�•�p Dw�t�.e� �� �� - <br /> Cescription of Work to Be Dene: _ _ <br /> NOTE: WIRING IN NON-DWELLINGS IS RE�UIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cedify thaP 1 have read and examined this application and know the same to be true and <br /> correcL All provisions ollaws and ordinances 9overning fhis type o/work will be compl2ted <br /> whelher spealied herein or noL The granting ol a permd does not resume fo give aufhonty to <br /> violat' r cancel fhe provisions ol any ofher sfate r local law reguP(ing construchcn or the <br /> pedoi. dice conslruc6on. Thaf 1 am authoiize by;he owner o/tbis property fo perlorm fhe <br /> work lor which ppfrcetion is,mad n�l mply ifh fhe Sfate Contracfors Law 18.27 RCW and <br /> 296200 W9C. � <br /> C ` _ ( - � \ � l �S <br /> Signa ure Date <br /> .� <br /> � �J�� � <br />