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�LECTRIC�L PERMIT APPL�CA i ION <br />CITY OF EVERETT PERMIT SERVIC�S <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8P57 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM g AM TO 4 PM - DEBIT & CREDIT CARDS /�RE NOT ACCEPTED <br />aG is i��k; �%�n�Gk� - vn.r�t- '%9-U <br />PROJECT ADDRESS <br />y�s <br />sG� <br />��NF���ti c��,ti� ,anTs z�,is no�-� �����f�. 9�.�0 � <br />zyi�l <br />Owner Mail Address Ciry Slate2ip Phone <br />Tenant Mail Address City State2ip // P� ne <br />7 �' <br />�Y�9,ul�f� S'r 1 3l o � �c v�w�c? �v..uF �1lkNF1'.% ��r� 9f��� �S� -.�✓Gl <br />Electncal Contreclor Mail Address City State2ip Phone <br />��'�-ArvSJ /'/.i L/' <br />State License Number <br />�►�°i �} <br />Proposed Use of Building <br />��d �, t <br />Contract Price of Work <br />Contaci Person (Plan Raview) <br />Descriptionof Workto Be Dene: C',.�L /�(C. r,�U%L,(,l% ���c,b��L E�L�^/I /1'(�/ ��� <br />C�h�l� T?� �IU i7- ,A- '�A" l'N•f,�-; <br />NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO <br />BE IN Ri�,CEWAYS, MC OR AC CABLE. <br />CITY OF EVERE77 LOCAL SAI_F,y TAX CODE IS 3105 <br />I hereby ceRi(y fhat 1 have read and exammed fhis app��cation and know fhe same fo be true and <br />correct. All provisions of /aws and ordinances governmg this type o/ work will be completed <br />whefher speciGed herein or noL The grenting o/ a perrvt does not resume fo gve aufhority ro <br />vrolate or cancel the provisions of any other state or local 12w reguPting constru�;hon or the <br />performance ol consfruchon. 1'hat 1 am authonzed by (he owner o( this property to peAorm the <br />�vak lor wnich application is made and I comply w�th the State Contractors Law 78.27 RCW and <br />296.200 WAC. <br />G' </� <br />% <br />FEE <br />3s �G <br />Eo4iz-iZ9 <br />