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�� � t//� — O 'LS <br /> 1 <br /> 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.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> lc,oc7 h'��<:, , rr a��� <br /> PROJECT ADDRESS <br /> ��� <br /> '/S L'c1./�'/ .j✓i_ .�r��-- .- - ,' <br /> I 'VI' lLFir` (�L6['-/' j=l� �G � T/ft' /I��T I_ .�'I<'Lrt � /�4- % !"'J_c7 � <br /> Owner Mail Address Ciry State/Zip Phone <br /> �% �% ,:.�-��,—y sk.�.r — <br /> Tenant Mail Address Ciry Slate2ip Phone <br /> I� J� _j/ �t -!L'L SL• yl�) - ]l J-i��13 <br /> fl���/1 � •f ' �Cl� � �;C(��- -I_'/ ce c� i`' h �t:i i% .,� `�c�'ZCJ� <br /> Electrical Contraclor Maii Address Ciry State2ip Phone <br /> _>� <br /> ,f,_/j: �%'�'- yC'.._ /, ( /C��� <br /> State License Number Contract rrice oi Work <br /> .!- (_� ! �L / .t=Pi . <br /> Proposed Use of Building Contact Person (Plan Reviewj <br /> Oescription o(Work to Be Done: !I � � / S � • i� �'' � �- j� <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEW.4YS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALE:i TAX CODE iS 3105 <br /> I here6y certi(y tha!I have read and examined this application and know the same to be true and �(�y�Z-�'�71 <br /> correct. All provisions ollaws and ordinances govemmg fhis type ol work will be completed <br /> whether spea�ed herein or not. The g:anting of a permd does not presume to give authonp�to <br /> violate or cancel fhe provisions or any other state or local law regu(ating construction or the <br /> peAormance ol conscruchon. That I am authonzed by the owner c/th�s property to peAorm the <br /> work!or which application is made and I comply wifh the Sfate ConVacrors Law 18.27 RCW and <br /> 296.200 WAC. <br /> , . �_�._. �• � �C: -� �L <br /> � '�`��� — <br /> Signaturo Date <br />