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( <br /> ELECT�ICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> �� �I �v�� E��-�� $t"z <br /> PROJECT ADDRESS <br /> �V � � � ���' 1 �I�� � � �Ok � �� ��� J��.��C � �L..�"• ��J � I� <br /> Owner I Address City Slate2ip Phone <br /> 4 Zs�3�- ,�Z <br /> Uc�ca,.�� <br /> Tenanl A7ail Address City State/Zip Phonc <br /> �, Lv �\Q 1/ <br /> [IeClfiC31 ConUadof fdail Addiess City Stale/Zip Phone <br /> �` �.+' � 5 lJ �a <br /> `+V�;1 �(;' <br /> State License Number C-�ontracl Price o(Work (' <br /> r. �/Cc 1,\�F \ '\C( 1"�`� <br /> N PI_'= �� ��' > .�C`t..�C\' <br /> Proposed Use ol Building Conlact Person (Plan Review� <br /> Description o(Work lo De one: � "� ��� `` I� � ��CrytCCc I C ���°C<<r�� <br /> 1 �, <br /> �l � C' � C cc 1—P � �fi' �. 1��^�.`'� _ �'i', � � � <br /> ` <br /> NOT[: WIRING IN NON•DWELLINGS IS REDUIRED TO FEE <br /> D[ IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certi7y th�f I hare read and exantined fhis applica(ion and know the sarne to be Uue and <br /> correcL All provisions of laws and o��finances govem�n�fhis type oI�vork will be complefed <br /> �rhether specAieAherein or noL The granting o/a perrnd does nof presume fo give aufhority N <br /> violale ur cancel fhe pro��isions el any other sfafe or local law regulnting construchon or the <br /> perfonnence o!consfruclion. Tl�at I ant authorized by fhe o�rner ol lhis property fo pe�fomi tbe <br /> work!or�rhich applicafion is made and I cornply�vifh the Sfafe Contractors Law 18.27 RCW anA <br /> 29G.200 WAC. <br /> ��)!�� 'tC% 1 lc =t, �Z - ��1 � Z6/G <br /> �SiBnature � Date I �" <br /> � �I� <br /> � <br /> 2/ <br />