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ELECTRIGAL PEI�MlT APPLIC.�TION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EV[RETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org �_ � �I—/D <br /> APPLICATIONS ARE ACCEPTtJ FROM 8 AM TO 4 PM �lnd�V�D� <br /> PROJECT ADDRESS <br /> /� �� � <br /> �`� "� t717 �i �' 311���C'/�C' l�/U �G��/ � <br /> OWner Mail Address Clty SlalerZip i•ho;ie <br /> , r ��d�� ����e'fl 1����e <br /> �T/�����L�''/�J�'�I "� �-' 4It� �,C/C� ��/% �1/ <br /> Tenanl � Atail Address City StatelZip P6onc <br /> [leclrir,a�Contraclor I.tail Address Ciq- Slaate/Zip Phone <br /> " , /.,� .�; , /• . ��� <br /> �State License Nuniber Contracl Price of Work <br /> Proposed Use o(Buildir•:, Conlacl Person (Plan Review) <br /> � � � � / <br /> Desc�ip6�:i al VJork to�c i?une: / � ^ ' �� C �/� � ` <br /> � <br /> --� I - <br /> Yl .. ,�—�_, o �1v ['. r '.. <br /> —� <br /> _ � 'l i_ G_ L- ��C�1LLL�..� i �/"��� <br /> 1 <br /> NOTE: WIRING IN ':ON-DV1'ELLINGS IS REQUIRED TO FEE <br /> B6 IN RF,CEWAYS, tiIC OR AC CADLE. <br /> ( CITY OF E1,'ER[TT LOCAL SALES TAX CODE IS 3105 <br /> 1 here6y certif��(hat 1 hai�e read and exarttined tl�is applica(ion and kno�r the snme fo be t�ue and <br /> �,)cv�- i� <br /> cerrocL .411 provisions ollau�s and o�cii�mncas goveming this fppo o/u�ork will be r,ornplr�ted <br /> nhelher specilied herein or noL 77m giartting o/a perruf does not unsun�e to give aufhonf��fo <br /> ���.�lafe or cancel the provisiens o!an}�nfher state or/ocal law regulafina construction or the <br /> pe�fem�ance o/construcfion. Thaf 1 am aufhorzed by the o�ti�ncr o/this propert}�to pr�form fhe <br /> irork lor which applicafion is made and I comply wifh!he State Uonfracto�s La�v 18.27 RCW and <br /> Y96.200 WAC. <br /> , / <br /> I i '�t`ll'��� l � ��i� <br /> --•`' -- — — <br /> � SignaNre U le <br /> �-- ---- ---- <br />