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i <br /> � <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-25 i-8810 - FAX 425-257-8857 -www.evereltwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> 't�/�I G�f'^.Cr� �I�r ��'--�'� <br /> PROJECT ADDRESS <br /> i /' �/Z� <br /> _�r��it`S S� - trf /�/!� Li.4',etS �6� �v�72t�JT ( �/�'r 7['7��1 25z - I`�c' 4 <br /> Owner ldail Address Cily Stale/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> SCz/: <br /> Electrical Conlraclor , Mail Address City State2ip Phone <br /> Slale Lir.ense Number Conlract Price of Work <br /> 11.�i::�L�t% <br /> Proposed Use o(Building Conlact Person (Plan Review) <br /> / � �� � �� �1 <br /> Descriplion of Wark to Be Done: L � '���N�l � t���"'�L1 �- I ti�1 �-� <br /> NOTE: N1IRING IN NON-DW ELLINGS IS REQUIRED TO FEE � <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCADSALESTAX�ODE IS 3105 <br /> � � <br /> I hereGy certi7y thf�t I have rea�, d exarnined this application and Anow the same(o be frue and <br /> correcL AId provi9ians of/a�vs id ordinances c�overnmg this type oI�vork will be completed <br /> wheUier srecified'herein or n , The granlinc�o(a pemut does not reswne to give aulhonty to <br /> violate or,,cancel tAe provisior s oI any other sta(e or local la�v re�uPting cons(rudion or fhe <br /> peAomi nce of cehsfruction. That 1 am aulhorized by the ownero/fhis properiy fo perfomi Ihe _ I I <br /> work(or which appfication is i iade and 1 comply wifh fhe Sfate Confractors Law 1827 RCW and <br /> 296.2001NAC. \ I <br /> � O`� <br /> �'-- . . '., � L � 6'(.' ��� <br /> Signatwe , Uate <br /> /, <br /> � <br />