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ELECTRICAL PERMIT A�PLiCATION <br /> � CITY OF EVERETT PERMIT 5E�r2VICE5 <br /> 3200 CEDAR STREET, EVERETT, VVA 98201 <br /> 425-257-8810 - FAX 425-257-8857 –v.�v✓w.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> �l� � K-. \�,� i i V� L K�_�_ <br /> PROJECT ADDRESS <br /> � � I� <br /> % C��Z��i_ _>'�l � �,7�r�-G1�1�� t�� . <br /> O�vner Mail Addrnss Cily StatelZip Phone <br /> Tenant A1ail Address Ciry StatelZip Phone <br /> �I1 A- �t-r� �c c' v �c j6s �ren��r��� �'�� ��Si � �oz�i�� <br /> Electrical Contractor Mail Address Cily ^ StateQip Phone <br /> I`l��AT�ti�-fi �f�-1�1 t� `'� /� . ���-�h� 7 Svv � — <br /> Stale License Number Conirect Price of Work <br /> ����I��-.�;��d L ��� r^1 — <br /> Proposed Use of Building Contacl Person (Plan Review) <br /> DescriptionofWorktoBeDnne: �I�� �°�F:S�-��' ��ll��� A��� i-no» ��UI�C <br /> L �! � 5 T/ 1) �: �i�+Lsl �i C _. <br /> — � <br /> NOTE: WIRING IN NC�N-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEl4'AYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAI.SALES TAX CODE IS 3105 <br /> I he�eby ceriily that I have read and ezarnined fhis application and kn�w fhe same to be true and <br /> cn�recL All provisions o//a�vs and o�zlinances govemmg tlus 1}-pe o(work�vill be completed <br /> u�hcfher spealied herein or not. The grantiny o/a pernut does nof �esume fo give aulhority to <br /> vio;afe or at�cel Ote pro�isions o(any ofher slate or lecal law re�uPting constn�chon or the <br /> perlor/n�ce o/const .fion. That 1 arn aufhorized hy fhe owner ol�his propedy fo peifomi the <br /> �vork lor a�hich�qpli on is made and 1 comply wilh fhe State Confractors Law 79.27 RCW and � � <br /> 29G.200 wAC. � / <br /> , <br /> I ! ' i �' <br /> �— �D U � <br /> � gna�ure 1 � ate <br />