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( <br /> ELECTRICAL PERMIT APPLICATfON <br /> CITY OF EVERETT PERMIT S�RVICES / <br /> 3200 CEDAR STREET, EVERETT, WA 98201 �7 ` �O— <br /> 425-257-8810 - FAX 425-257-8857 –www.evE�,ttwa.org �OgD� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> ����� � �� r-_ C-��«�.�a A ,,z <br /> PROJECT ADDRESS <br /> /,�� p /�. <br /> C'J �1 .-7 � 9 /"�Cn. C�<ti —t �L.�.�Si .,� � �-[7� � ����,..C� N-r4 �➢�Z.H ��ZV� ��-S �J �Sp <br /> Owner Mail Addross City Slatr,IZip '�+one <br /> TenaN htail Address Cily Slale/Zip Phone <br /> (' ��' • �: ; <br /> El�clrical Conlraclor I,tail Address City Siatc2ip Phone <br /> Slale License Number Conlracl Price of Work <br /> Prrposed Use of Building Contact Person (Plan Review) <br /> Description ol Work lo�e Done: V r �� �• , e Q c-I d� �i � . , <br /> NOl'[: WIRING IN NON•DW[LLINGS IS RE�UIRED TO fEE <br /> BE IN RACEWAYS, MC OR AC CA[3LE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 her�7y certily fhat 1 ha��e read nnd ex�mined this applicafion and know fhe same to be iru�and �t:- `���,, ._ �}j� <br /> conec�. All provisions o/la���s and or�finances govemmg fhis fype of work will be cornplefed <br /> whefhe� spea�ed hemin or noL 'fhe granfing ol e pemid does not �resume fo gi��e authonty fo <br /> vrolafe or cancel L'�e provisions o/an}�other stafe or local law regulating wnsfrucfion or the <br /> perfomiance ol cronstrucfion. That 1 am aufhorized b��tf ie owner ol this property fo perlomi tlie <br /> work lor which applicnfion is mnde and 1 comply with fhe Stafe Confracfors Law 18.27 RCW and I <br /> 296.200 WAC. <br /> ��. � �� ,� <br /> � ���'12Uf�( i l �:/r,�„^.— �, � � � ��<,� <br /> �,SignaWre Uate <br />