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�LECTRICA� PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROA1 8 AM TO 4 PM <br /> -, � � <br /> i � ;`r�o � / � ✓�� <br /> PROJECT ADDRESS <br /> ��' / / A r n� n .�, <br /> c• =2M1 JL /7/.I..i.�Ai, ` v�i I1/�j/^�!t!�'Id� G !/G/�C( l ��^ '� G� c-UI YI��S�L-��'7'�"�-b <br /> �Owner MailAddress City S1ate2ip Phone <br /> .� � 1 <br /> n 7� <br /> ._If� i: e- i ,,� ,��,'i' ; 7 i :� I� H ! C� '✓'c`)'C;�� � �.�,� �, �.: bl _ <br /> Tenanl I.tailAddres^ Cily St.�e'Zip Phcnc <br /> ../ .. <br /> � [IeClfiCal COnir;+ctor 1.1ai1�ddross Ctly St�lc/Zip Phonc <br /> i-/ '�; <br /> %✓ /.-�' <br /> Slale License Number Conlract Price of Work <br /> . '' _ . � ' ' . --- <br /> Proposr-; Usr,o� L�uilding Contact Person (Plan Reviow) <br /> DescriplionofWorht�.� DeDonc�. ���1'i^L� t .� /`_,�•. ; :; c /��� i; [� -- �: c �� f'�:-� i� <br /> �V/r ta/ : 1�./�ic_ C� CNi�tf7F' C t� � D,�//�ucl f/�� ( <br /> NOT[: W IRIfJG IN NON-DW ELLINGS IS REQUIRED TO FEE <br /> DE IN RArEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hnraby�e�7ify fhaf I have read and examined this application and Fno�v the sarne to be true and <br /> conecL All provisions ol/a�vs and ordinarces c�ovenung th�s type ol work will be complefed <br /> whefher spec�6eAherein or noL The g�anfing o!a permd does not resurne fo give authonty fo <br /> violafe or cancel fl�e p�ovisians olany ofher sfate or local law reguPfing construchon or the <br /> pedom�ance ol construchon. lhaf!arn aufhonzed by fhe owner oRhis property to peilorm fhe <br /> �vork lor whiclt application is nmde and 1 compty wiU�Ihe S:ate Contractors Law 18.27 RC6V and <br /> 296.200 WAC. <br /> i <br /> /� . / j /�� � , <br /> � �����C, � i'4�6���—_ u / � <br /> Signature D�teT— .� , (,� L� <br /> i� <br /> ii <br /> � � <br />