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i <br /> ELECTRICAL 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 /> �U �/ ��-S �� � �8�?D3) � �/�S_�?3�-�'l�' <br /> PROJECT ADDRESS � � <br /> l�2D � � D���G �� 3�5� �v����L��!j <br /> Owner p1ailP,ddress Ciry Stale2lp Phone <br /> � <br /> Tenant �1ail Address Ciry Slale/Zip Phone <br /> �LL�/L��lc <br /> Elecl�ical CoMtaclor Mail Address Ci�y Slale/Zip Phone <br /> State License Number Contracl Prico o(Work <br /> Pro{wsed Use o(Building Conlacl Person (Plan Review) <br /> // c �_ <br /> Descnplion of Work l0 6c Dono: �(`�i������ � " ��- �/ <br /> NOTE: WIRING IN NOtJ-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES lAX CODE IS 3105 /y� l I <br /> 1 hereby cwti/y fhaf 1 havo read and examined(his epplication and kno�v fho same fo be Vue and �--�J_�� T � ` �� <br /> conect All pro��isions olla�vs and aelinancos govemmg this fype ol work will be completed <br /> �rhefher speaGeA herein or noL The�renting ol a permd does nof resumo fo give authonty to <br /> violate orcancel tho provisiuns o(any otHerstnfe orlocallaw reguPfing wnstrucfwn or fhe <br /> performance ol consfruction. Thof 1 am euthonzed b}�fhe o�rner o/(his property fo perfomt the <br /> work for which applicafion is made and I comply�rifh the State Conf�ncfors Law 18.27 RCW and <br /> 296.200 WAC. <br /> i � <br /> � ,��� =� ` , ''/ �`,,% �� <br /> SignaWre � al / ' <br />