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ELECTRICAL p�RMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 320Q CEDNR STREET, EVERETT, W� 98201 <br /> 425-257-8810 - FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS AftE ACCEPTED FROM 8 AM TO 4 PM <br /> ' llv �r' l� � � ���C� /-�i� �? �; <br /> PROJECT ADDRESS <br /> I� l� '���C �'�n l�"(!� ` '^ �l(' l= '�' E h ! 17- r� ', v� <br /> OWner M11ail Hddress City StatelZip Phone <br /> � <br /> Tenanl Mail Address City Slate2ip Phone <br /> �' I �S �ZCiGFCt �y F- C� C % 7=U( /`'i�Jl;ll,�C'U )5i_✓R /_ ��, V,J.0 `��''� 'v'3 ��JS -�SS=S'06� <br /> Elecl�ical Conlraclor Mail Address Ciry StalelZip Phore <br /> � �C.0 _ <br /> '-'' lS(s�vC% i�%�� nv � c� � <br /> Slate License Number Conlracl Prica of Work <br /> � �_ _ i� <br /> Proposed Use of Building Conlacl Person (Plan Review) <br /> Descripliono(WorktoBeDone: i•�.0 / /:' � ( L�- �� -,�..L� - /�; h✓ � /7� /�P� �l�/l�i 5.�.<�cr. <br /> _ � <br /> NOTE: WIRING IPJ NON-0WELLINGS IS RE�UIRrD TO FEF <br /> BE IN RACE4VAYS, MC OR AC CABIE. <br /> I I <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> i <br /> �� I I lieiebvi ceni!y fhaf I have read and exarnined fhis application and kno�v the sarno to be fn�o and — C'v �7� �v� �"t <br /> '� correcC All provisions olla�vs and ordinance^goveming this type o(�rork will be complefed � <br /> �vhefher speci(ed herein or noL The�ran(ng ol�perrnrt does not presume(o give aufhonty to <br /> vic!afe or cancel fhe provisions ulan}�other stafe or locnl la�v regulatinc�construchon or the <br /> pe�formance of cons(ruction. That I am aufhorized Gy fhe o�vner uf fhis property to perform fhe <br /> work/or which application is made and I compl}�with fhe State Contractor;Law 18.27 RCW and <br /> 296.200 WAC. <br /> , _ ' - i � - /%-� �: <br /> ;' . � �; r� , �. <br /> � Slgn�lure � Dale <br /> �—_. _ ..--__— —_ <br />