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Et_ECTRICAL P�I�MIT APPLICATION <br />CITY OF E��ERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERGl"1", WA 98201 <br />425-257-IIS � 0• FAX 425-257-8857 — www.everethva.c�rg <br />APPLICATIONS pRE ACCEPTED FROM 8 AM TO 4 PM <br />i <br />%�', � � i f � �� -i �\ �' �� i� � � �,'r �,�,-N �,�, i� <br />PROJECT ADDRESST <br />Owncr <br />IJail Address <br />Cit� <br />State/Zip <br />Tenanl MailAddess Cily ij�_--'r,� SWt^2Ip <br />, � <br />�, i,: � 1� �' � [� � l <' c � � � L � �1� "�l l r � �� �� F''<' � ,1L �: �.I �: � �� j��,�-lc�t, �� �'� � i <br />Eleclrica! Contraclor Mail Address Cily State/?ip <br />�, � i: , <br /><<- :���1 � �; I-� ' l �. � l . �-I - <br />Slate Licensa NumDer Contract Price of Work <br />Proposed Use oi Building <br />D�>scription of Work lo De Done: ���� �--�� ' �1-� ��� I I s <br />NOTE: W IRING IN NON-DW[LLINGS IS REQUIRED TO <br />BE IN RHCEWAYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 <br />Phune <br />Phonc <br />� ��" �� � ' <br />Phone <br />Con!acl Person (Plan Review) <br />� <br />os-1 c, � 1�=. -4 C ��-�- <br />1 hereby certily tha! I have read nnd �xarnined this ap��licafion and la�o�v the �ante to 6e frue and <br />correcL All piavisions o(laws and ordinances governmg fhis type ol u'ork will be complefe�i <br />�vhether specdieil herein or noL Thc granfin� o/a pern�d does not presume to give eufhonty fo <br />violale or cancel the piovisions ��I any other state or loca! law rege�ating construction or fho <br />perfornranca o/censtruchon. That 1 am authoiized by fhe o�vner ollhis property fo pedorm fha <br />work lor u�hicli applicatron is rnade and 1 cornply �rith the State Contractnrs Laiv 1Q27 RCW and <br />296.200 WAC. <br />__ <br />�,:�_ : �-,. 1 �� �� <br />� <br />�'+!:'.-tt-!--`�_.�. . . : �:� _ _ 7 / � , <br />Sianature Date <br />FEE <br />�ItnS ��`� <br />\ .. <br />�, �r �. _ � � . <br />