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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.=vereriwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM -DEBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> ��o�,���� �vN �i�— <br /> PROJECT ADDRESS <br /> TW iL S�� <br /> Owner Mail Address Ciry State/Zip Phone <br /> �S /�1�.�� � <br /> Tenant MailAddress City StateZp Phone <br /> l���r�eit'7�eJ� �ls� ��'$. !ws �.�crL�n.�� uA� naZt r uLc,���_u�oy <br /> EIeCViCaI ContraCtor Mail Aduress City StatdZip Phone <br /> �c�[�F'9(o5L.5 � <br /> State License umher Contract P ca of W ork <br /> /Y44P.L1-`7 S�7tSLeS <br /> Proposed Use of Building Conlact Persan (Plan Review) <br /> /i ��,, �/'� <br /> Descriptian of Work to Be Done: �/aQZ� �-?�dl/c= ��?U � ,�/U� �L 7G�Sp/ <br /> ��'L�l�r;� `� cNU A ,���•r� s� S�N�r��o's �A-k-�� <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN R,4CEWAYS, MC OR AC CABIE. <br /> CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> 1 hereby ceRily that 1 have read and exsrnined this appl�cation and knoK•:he same to 6e frue and <br /> correct. All provisions o//aws and ordir.;nces yoveminy this type of work will be complet�•d <br /> whether speci�ed hereln or not. The granting o/a perm�t does not presume to give authonty to <br /> violate or cancel the provisions o/any other state or local iaw reguleting conshuction or the <br /> peAormance of conslruchon. That I am authonzed by the owner of th�s property to peAorm tha <br /> work for whlch application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> '� � <br /> /�.�.�l,l � �-+K,�— r�,���a?� <br /> Signa�ure �at � <br /> eb�� -13 � J <br />