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z <br /> . <br /> �LECTRiCAL P�RMIT �APpLICATION <br /> CITY OF EVERETT PERM17 SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-&810 - FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ( ( —I ��,J6 <br /> � �� <<� �f ���'� ��(, <br /> � � <br /> PROJECT ADDRESS <br /> ; � �i/ <br /> ( � �2��a: �j � e ..�- � <br /> Uwner Mail Address Ciry StatelZip Phone <br /> Tenant Mail Address Cily State/Zip Phone <br /> >�� �,� ;n...s� £_1CL•\ ✓� L <br /> Elecirical Conl�ccto� Mail Address City StatelZip Phone <br /> �l��^^.�^-�e�.;�-I 7�7 Ci[,�t <br /> y�� � �G �j <br /> �lale License Number Contracl Price o(Work <br /> Proposed Usc o(Building Contacl Person (Plan Review) <br /> i �_ V/� <br /> Description of N'ork to Be Done: �� l� �J /_.o -.���{� ,. � ��-�--�' \t' '='-``� l 1 � <br /> " I NUTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> � <br /> BE IN RACEN/AYS, MC OR AC CABLE �. �= <br /> � V� � <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceitily;hat!have read&��d examined fhis application and kno�v the same to 6e true and <br /> correcL All pravisiais o(/aws and ordinances govemma fhis type ol�vork will be completed <br /> whether specilicd herein or noL �he granting o!a permit does not presuma fo give authurify fo <br /> violale or cancel lhe provisions oI eny o(her state orlocallaw regulating construction or fhe <br /> peAormance o(consfruction. That I am authonzed by the owner ol this property to perlorm the <br /> work lor ivhich application is r�ade snd 1 compl} �vifh the Sfate Contractors Law 18.27 RCW and <br /> ?96200 WAC. /, � <br /> ���":- /-�L_— /l�_� �o� <br /> �Signalure,-� Date <br /> ,- / ,q s <br /> cUL; li - c <br /> — ,.�y. ,�.,: - - �F7` ,5" �-" ,�-��*:�=� <br /> .. -:�:.G . ,. " .., . -.. fL'.1�4 r,:x :: <br />