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EL�C�'RlCAL PERMIT APPLIC�4TION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CFDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — w�n�.v.evereth^✓a.org <br />APPLICATIONS ARE ACCEPTED FRONI 8 AM TO 4 PM <br />� � 15 i�l.Ar�� <br />�ROJECT kDDRESS <br />(=� ��-TE�-.`�i hJ !-!o rn C `�, <br />Owner Aiail Addross <br />Tenant <br />Mail Address <br />Cily <br />Cily <br />Staie2ip <br />State2ip <br />3 —3 —�� <br />�"o8a 3-�3 <br />Phane <br />Phone <br />�����'�r I�C�c,—rfLi� C �:� �-61�T�T NlJ 5-►'ANwaaO c.�A �`e2'i�� �-l2; 3or, 5�5; <br />Eleclrical ConUaclor Mail Address Ciry State2ip Phone <br />,��rnr��, IC� r�m K_Z <br />Stale License Idumber <br />Proposed Use of Building <br />b� /,1 0 J <br />Contract Price o( Work <br />Cortact Person (Plan R�aview) <br />Descriptiun o( Work to Be Done: _ l.�l i�C. N�..�.J ��.F,r�- , L��v l� M� S C�.v � LC _ <br />IJOTE: WIRING IN NO�I-DWELLINGS IS RE�UIRED TO <br />BE IN RACEWAYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALE3 TAX CODE I� 3105 <br />I hereby ceiiily thaf 1 have read and oxamined this ap/.�iication and know th^ same to ba (rue and <br />correct. Alf provisi�ns ollaws and ordinanc�s gcverrin� this type ol work n�ill be cor.:aleted <br />�•:heUier specdieo harein o� noL T!�e granting c! a pemw does not �esir, ne to gi��e a,rthori;y to <br />uio/af� cr cancel the provisicr,s o/any olher sfale ur lo,:al law re�uPhng corstru�fion or fhe <br />performauc.e of construcfion. That 1 arn aut6ori,-.eci by ihe ow•ner ol fhis prope�-rtv to peNorm ihe <br />work /or wh.ich appl,cahon i:; made an�i 1 coriply ctiifh the S(ate Confractors Law 18.27 RCW and <br />2�J6200 4l�AC. <br />1� p <br />� <br />--� J._ / _` ---- .j J i� O <br />Siynature �ale <br />FEE <br />�{-V �' 7 L�C% <br />