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� <br /> E�.ECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810 - FAX 425-257-8857—www.evereltwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO�PM <br /> z(�nC 't"1�(lJ.�� \ � 17U'L�1UL <br /> PROJECT ADDRESS <br /> C ��� JF �u4�t� ���UL� �r c,2,i ,�-t4.� ��LV�Lf`�''ct '{`Zc3�l c��as� as�- �SF�o <br /> ON718� Mail Addess Cfty State2ip Phone <br /> �L:�4+E'1�' eO��C��'��c�b C�`�C�U 5����.JC{� tlU��v\U`�� �V4�r4T� �( �d0 } ( yas1 �3`7`(-�oy4 <br /> T9nanl NWiI Address City SWiNZip Phone <br /> ,(j�i110 lU2�Yl� T��r �IFxY� '�2<bcvl �'U�c S�n:ie.;0,'-� `��• �a1leC� L.u� �I��Z'l`� (1125)3N�j'S�'4W <br /> Electricxl Contrador Mni�Pdeieas Ciry Stete2ip Phone <br /> APOI.LN"I - U�1N-OfJ � 1G � "' <br /> Stete Licenne Number Conhad Price of Work <br /> �`'JV�VV�`(�f�C 12.1 t�d.�l F� � \'rv1 ��� <br /> Pn,��sed Use of Buildirg Conlacl Person (Plan Review) <br /> Descnption of Work to Be Dane: 1 H'�'�-2 l\ L�> � 1�u w.��.n2-"f-.(i� �r1 c�r 1�.r� �� i i 1 v� <br /> T� �'"�_ <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS,MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAI(CODE IS 3105 <br /> I hereby certiry thaf 1 have read and examined this appl�icafion and know the same fo De trtre and <br /> cnnscf. All piovisions of lews and ordinances govemmg fhis type ol xrork wdl be complefed <br /> whether spec�ed herein or nol. 7ha granlirg ol a permrt does nof pissuma to give auMaity to <br /> vidale or cancel fhe p�ovisans o/any othersfafe orlocal lnw regulafing conshucfion orfhe <br /> pedormance olconstrudion. fiat!am aufhonzed 6y Me ewner ol this proper7y ro peAorm Ma <br /> wnrk lo�which appl'�cation is mede anA 1 compty wifh the Statn ContraCors Law 7827 RC W and <br /> 296200 WAC. <br /> ��'�l.'V� �1�� ( ' ��t— �� <br /> SignaNre Dale <br /> �c �v� -� 9) <br />