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( � <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES 5_�7�5 <br /> 3200 CEDAR STREET, EVERETT, WA 98201 �,q <br /> 425-257-8810 - FAX 425-257-8857-www.everettwa.org (70505 z/r <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM -DEBIT 3 CREDR CARDS ARE NOT ACCEPTED <br /> � nn � f"/G,J% � /il%Z <br /> PROJEC ADDRESS <br /> yRQ� l f/lcv� ?� i9`� <br /> s/'oirTl �'�c�F E.Ii/'��PSJJ E�il��7 G��I• <br /> pymg� Mail Address Gly StaleZp �� <br /> Tenant Mail Address City SfatelZip Phax: <br /> � <br /> 360 ., <br /> /S/s'A �i?Pe ri��� /�iliYe., .hT• l�Pila•o.�. Gd9 9d � 7? {!!d�-�kJ S` <br /> 7 T �� <br /> Elecl�ical ContfaCtOr Mail Address Clry StaMfZip <br /> SiG.�urh /�� T ��G `�IZI" / <br /> State License Number Contract Price of Work <br /> s ;G ,�n� � �`ys �c /3 <br /> Proposed Use of Building Contact Person (Plan Review) <br /> Descriptian ot Work to Be Done: /A�1 ��l L�iti7 �r/P�/� S7?j� ��' �f'.vg <br /> i <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO �E <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby certity fhaf 1 have read and examineA fhis application and know fhe same fo 6e true and <br /> correct. All provisions of laws and ordinances goveminq this type o/work will be completed <br /> whether spea�ed herein or,nof. The granfing o/a permit does not presume to give authority fo <br /> violafe or cancel fhe provisions ol any other sfate or local law reguleting consfrucfion or the <br /> perlormance o/construction. That 1 am authorized 6y fhe owner ot this property to peAortn the <br /> work for which application is made and 1 comply with the Stafe Contractors Law 18 27 RCW and <br /> 296.200 WAC. <br /> �� / �/�� � S��/"� S <br /> Signature � Dale <br /> �O.S�JS-OQ. � <br />