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� � <br /> ELECTRICAL PERMIT APPLlCATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 y�'a'�—�� <br /> 425-257-8810 - FAX425-257-8857-www.everettwa.org �/00�/-�03 <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> �. �� � /r4.��P /¢U� <br /> PROYCT ADDRESS <br /> G� G�v'r S/ S�xule �3o E G.x«�.Cr�i� �'� Q...�.��.� P�'.zo� .css- <br /> OWner Mai�Address City Stale/Zip Phone <br /> _ SG. _i <br /> Tenanl A1ail Address Cily Slale/Zip P;ione <br /> QS oT �u ��� F.,.�.-rt �..,,,�- �F1o3 y.ts ssrSsy <br /> Elecldcal Coniractor Mail Address City Slate/Zip Pnone <br /> �S�£G xX ol z d � b.�� <br /> Slate License Number CoNract Price of Work <br /> L��S <br /> Proposed Use of Building Conlacl Person (Plan Review) <br /> Descriplion of Work to Be Dono: �{e(� Oe�f� �'_o r ��c�S C q�5,�,�.� <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 '5 <br /> 1 hereby certily thaf I havo reod and exemined U�is applicalion and know fhe sarne(o bo truo anA E I Ud�—�Q j <br /> correct All provislons ollaws and ordinances govemmg fhis type al work will Ge complefed <br /> whefher specifieAherein or noL The granting o/a pemuf does nof resume to give aufhonty to <br /> vlolafe or cancel fhe provisions ol any ofher stafe or locol law reguPfing wnsfruction or the <br /> peAormence o/construcfion. That 1 am eufhonzed Gy fhe owner o/fhis propeAy ro perfomi fhe <br /> work/or which applicafion is made and I comply wifh the Sfafe Confractors Law 18.27 RC W anA <br /> 296.200 WAC. <br /> ��`/����.� Y 'r7s' 1C�/l5 <br /> Signaturo Dale <br />