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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857-wvuw.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> �C� 1ci `� I a1�u �� . <br /> PROJECT ADDRESS <br /> � �1,�5�� �9�n`r <br /> �c� � � �:�-L���_n I� i,�,,�� i�,� <br /> Owner hlail Address Clty Stale/Zip Phone <br /> Tenan� Mail Addrass <br /> City Stale/Zip Phone <br /> "' ��a--�:�i - i7�i794/�»nn 'Q C'„nunm��l-l - c. ! �QIJ `�d��3�J <br /> Eleclncal Conlraclor ktail Address City Slate/Zip Phone <br /> .n or-�n.��- c7_4�� _l,�' `�,Oc]d— <br /> Slate License Number Conlracf Price of Work <br /> i <br /> _��l,�n � P �ii».�� � _ l�Jtr'1,1r .�� /��D � . <br /> Propo,e Use of Bwlding Conlact Person (Plan Review) <br /> �escriptionolWorkloDeDone: ���j,-�,; � �� rJ����y'y���., <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CtiBLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby ceifily that I h��ve read mid examined this applicnlion end know fhe sante to be 6uo and <br /> correct. �111 provisions o/la�rs and o�dinances goveming fhis rype ol work will bo completed <br /> n•hether specilied herein or noL The grantin�o/t�porrnrt does not presume fo givo authonfy to <br /> ��iolafe or c<vicel fhe provisions o/any ofher sfafe or local law re�ulefing consfrucfion or fhe <br /> pe�lormance o(construction. That 1 am aufhorized b}�fhe o�vner ol fhis property to peAonn the <br /> n�ork for�rhich applicafion is mnde and I cornply�vifh fhe State Conf�acfors Law i8.27 RCW and / �� <br /> 296.200 11�AC. <br /> � ' 9 � �G <br /> �_� � � �—• /� — — G, <br /> , )�� ;:: i ."'>/ "1�7 \ <br /> SignaWre ` Date <br />