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( <br /> ELECTRICAL PERNlIT APPLICATION <br /> CITY OF EVERETT PE�MIT SERVI�ES ��� s <br /> 3200 CEDAR STREET, EVERETT, bVA 98201 09y <br /> 425-257-8810 - FAX425-257-8857–www.everettwa.org �d�JoB' <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM 70 4 PM -DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> ,rYfG Ci/t;/�sFf//�ti� C�L%.tii'<'r�r.'i/C�- <br /> ! GC�' �%L'�>�'s�:`'� �C ✓t� <br /> r'- D�/-=.�-1—� / � l: �'"7 i C-'j i -�'..�— <br /> PROJECT ADURESS <br /> �i l,�/)�?ti"!'I/lt'/ i S�i}<-' <br /> i:LOc_ �� S.q>�:: �C� <br /> �,(.'�L> i /�/,•:N/J. C[ C Ct�!CJid,'lii,_ 1 �1� ( � ' �!` '.-�..r ��/� 7�GJr _ <br /> �.C+=_EEl�"..., <br /> Ownef � Mail Atltlress City Slate/Zip Phone <br /> J'i�� C/y6�fl.iv.Ni✓ <br /> �� d�/� :�/'p' /,Ui>.'s`:,�✓ i',Cf�'J Fl�''�.�i f; }. <br /> Tenant Mail Address City Slate2ip Phone <br /> L�� 5 l�ti/}%/iLi= -�C G- <br /> � /n.0 �/iST�1/�/C� �� 6il�'i'dG l i�- �i�'� l2 IY�-�?L%(- <br /> [[i � S�'t' �' <br /> Electrical Contraclor Mail Address Ciry Slale2ip Phone <br /> G" S �/ /'C J C%O`yG_ `� ��� �f���-i� �`� <br /> Stala License Number Cont ct Price of Work <br /> � �7� �-�fi-'��� , <br /> ��.<_��/�i"%�''�=C //��-- "T/�/�./ <br /> Proposetl Use o(Building Contact Person (Plan Review) <br /> DescripiionofWorkloBeDane: ��USr/�L� Cg-/ rH�-�/t'iL%S/ �}'( S �- - <br /> NOTE: WIRING IN NON-DVJELLINGS IS REQUIRED TO FEE <br /> BE IN RAC[WAYS, MC OR AC CABLE. <br /> CtTY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby certily thaf I have iead and oxamined this applicalion and know the same lo be true and <br /> conect. All provisions o(faws and oidinancos governmg fhis fype o/work will6e completed <br /> �vhether specdied herein or nol The granfing ol a permd does noi p�esume to give aufhonty fo <br /> violate or cancel the p�ovisions ol any other stata or/oca/law regulating construcGon or the <br /> performance ol consVuc6on. Tha(I arn aufhonzed by the o�vner of Ihis propeRy to pedorm the <br /> work lor which application is made and 1 cornplv�vith the State Contractors Law 1827 RCW and <br /> 296.200 WAC. <br /> �C`� ��,_L:i ���:�a�l� > 4 �/� 5 <br /> SignaWie i —�� Pa�e <br /> ��Sc� B • D�tz <br />