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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857—www.everethva.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> i�� 0 9 ��. �. ;� �-�:� i %s�s�, � -� c� <br /> PROJECT ADDRESS �� �ZS, <br /> I <br /> � ���1-�-� /y-e�/ .��- .�r3z..°�TI �, �3� J�7� <br /> Ownef �ls"��LI3"��}� ��,��. MailAddres Clty ' � State/Zip `y phone <br /> c—> T���\ , �-", //5�10 / �o�vt•eu, - 5'�f�!/7d ��1�4-b`+5',2 <br /> +..?�;����--�'�'->n/7rr� , �`+J��so. ✓ 9�{l7� �-17. PfT �v <br /> T��oant \ MailAddress City �,�� State2ip ��Sr <br /> /�csV .=✓mN�tJ-�'x� z'F/ z/��� 15r. �Cc` .sr��1�Z(:S l�l� �`�5� g�J �.7�. <br /> EIeCUical Conlrac�Or Mail Address City • State2ip Phone <br /> �c.�'J c�C_ �o%S� C :J �/>`Z' <br /> State Ucense Number Contract Price of Work <br /> �J .[ �,.,�.. <br /> �`J 1G�� 6'C�w . 1�.�'S� � <br /> Proposed Use o(Building Contacl Per�on (Plan Review) <br /> 1 n <br /> r/ / �`%�C /,�c^1' c^/y� ,�����`�' ) �,s� G,uS���c <br /> Descriplion of Work to Be Done: _/y�!•L[ / <br /> C � i `�- <br /> %I'�- �� ' / <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 here6y certify that/have read and exam(ned thls application end know fhe same to be true and <br /> correct. All provisions o(/aws and ortilnancas goveming thk type o/work will be completed <br /> whefher speclfied herein ornot. The granting o/a permrt dces nofp resume fo glve authority to <br /> vio/afe or cancel fha provisions o/any other stafe or locallaw regulaUng conshucf(on orfhe <br /> performance o/constructlon. 'fhat 1 am euthorized by the owner o/this property to iierlorm the <br /> work for which applicafion!s made and 1 comply with the State Contractors Law 18.27 RCW and <br /> 296200 WAC. <br /> ' „ ���'-�`- .3 = o _ �� 7 <br /> y _ �; <br /> Selrature Date <br /> % <br />