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( <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDA!2 STREET, EVERETT, WA 98201 q a� `/ <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org 7 <br /> APPLICATIONS ARE ACCEPTED FROM 6 AM TO 4 PM (��� �� �'� 7 <br /> � <br /> /�>�✓ G i-��- �.� /�v � <br /> PROJECTADDRESS <br /> ��3; Cl fi�,sG�c :� �U.Zs <ic�..<iC , v� L^v'�' Yi �.�./� �.5�+�� <br /> uW�e� �dailAddress Ciry State/Zip Phone <br /> Tenanl Mail Address City 3tate/Zip Phone <br /> l�.S�r� l`�C c /ic � .�-ti<�l �J �f-S'j. L–r/�' -t t' !ti•�' T.5".���) �f1S-iJS S.�y J <br /> Slale2i Phone <br /> ElectricalContrector MailAddress ���Y � <br /> Ds��L n�r ���z c3 Z- <;crU G <br /> Slate License Number CoNracl Price af Work <br /> 1� � < < Y <br /> Froposed Use of Building Contact Person (P�an Review) <br /> � �,�� <br /> Square Foo g(If resideNial new:onstruc�ion, remodel or adddion) <br /> Description o(Work to Be Done: lz��< < � � y� � �� `� � �'� ^' � <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. (i(O� <br /> � <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby ce�tify fbat 1 have iead nnd examined fhis applica�ion and know fhe same fo be tn�e and � I�On _ I I � <br /> conect. All p!ovisrons olla�vs and ordinances goveming this type ol�vork will bo comp/eted `�1 <br /> whetherspeci�ed hemin ornoL T/�e granting of a pernut does not pipsume to give aufhonty(o l <br /> violate or cance!the pr�visions o/any othcr s(ate orlocal la�v mgulatuig const�uction or the <br /> peAomimico o(consln�ctinn. That 1 am aufhonzed by the ownero(fhis prope�ty to pedorm fhe <br /> n�ork tor�vfiich applicalion is made and I comply wi(h IAe State Confractors Law 1827 RCW and <br /> 296.200 WAC. <br /> �–_.. /: � r --� ._ ,c�i — <br /> � �.'<.- - �"-`u.•3.% 1 .d— <br /> Signalure,� Date <br />