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( <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEnAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857-www.everetlwa.org / a�'a.p �- 1/ <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ���� Z���� <br /> ���, �E:c.k-S 11r, <br /> PROJECT ADDRESS <br /> Eu�r.�t 5�.1` J �1:ff�'C,- 4�3o cm)b,. Av� F���, w�4 SxzvZ ti�-�srs-ya�r� <br /> Owner <br /> Mail Addreu � ���Y Slale2ip Nnone <br /> c�ND <br /> Tenant <br /> Mail Address Cily State2ip Phone <br /> E.Lo.� : v� ,'�I Crezt w � w � -osr <br /> StatelZi Phone <br /> Electric I Conlractor Mail Address City P <br /> ��ALtF�..0�4t Nt1 �yi�•ur <br /> S ate License Number Conlract Price of Work <br /> 'r .� ni <br /> Pro�psed Use ot Building Contact Person (Plan Review) <br /> f1�. -P.Y.�++ns ,J -r� FlIl4-�/. £Xhc.r� <br /> Description of Work to Be Done: n�.�3' Q� ��^�`�� �`" <br /> ..Ir� �n�lT, <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 <br /> 1 hereby certily that 1 have read and examined this application and know fhe same to be frue and <br /> correct. All provisions o(laws and ordinances goveming this type of work will be.completed � <br /> whether speafied herein or nof. The granfing oI a pertrut does not presume fo give authonty to I I <br /> violateorcancelthe provisionso(anyotherstateorlocallawregu/afingconstructionorthe <br /> peAormance o(construcfion. That 1 am authorized by the owner o/this propeRy to peAorm the � <br /> work lor wh�ch applicahon is made and 1 comply with the State Contractors Law 18.27 RCW and � I I In <br /> 296200 WAC. �� <br /> ��/�- �Z z��zr"� <br /> Signalure Date <br />