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� � <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 S AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> 2�, D L Q/� IL- AV� <br /> PROJECT ADDRESS <br /> �� :��'S� 27�� <br /> !�r n�l����.c��Iz,y-r.�G 7oU�I k��E_-n,r `��1��� cJt! S'�057 <br /> Owner MaA Address Cny StatelZip Phone <br /> X�rr�� �i� 2�t�� dA �� ��� �v�2�it �`�� ����2� <br /> Tenant Meil Address City Stale/Zip Phone � <br /> �O�Z <br /> �nrv�� ���G7��r.�_ 7c�`f/ cT� ,av ►� Z��.1�►vto�D W� ��31�5- � <br /> Electrical Contractor Atail Address City � State2ip Phone <br /> � � � � <br /> �I �J ���� � rZ � � <br /> State License Number CoNract Price of Work <br /> Proposed Use of Buitding Contact Person (Plan Review) <br /> / , i ' � <br /> Descnpiion of Work to Be Done: / _ ' <br /> ClJt.�-c.�,� /�ZG�D' /.�CZ <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RAC:EWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereGy certily that 1 have read and ezamined tRis applicafion and knrnv the same(0 6e true and <br /> conecG All provisons o/laws anci orAmances governmg fhis type o/�vor6 wili Le completed <br /> �vhether specified herein or noL The grantm9 0/a pemut does not presucie to give aulhonty fo <br /> v�olafe or cancel lhe provisions n/any o(ha stafe or local!aw regWa6ng construc6on or the <br /> peAvmance ol construcfion. That I am authonzed by fhe o�vner ol this property to perform the <br /> work lor�vhich applicalion is made and 1 comply wifh the Sfate Confractois La�v 78.27 RCW and <br /> 2:,6.200 WAC. � <br /> '1 - � ..� <br /> ��' .�/ r r �/ � - <br /> gnatu Dale <br /> I' � <br /> _' � <br /> � � � <br />