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ELECTRICAL PERMIT ARPLICATION <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 /> APP!ICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �--7 `31 _ �--7 <br /> � <br /> � , C' CJ�b-7_ 1%.3 <br /> ,�J� a� ��,�rr,r✓!r 17riUl� <br /> PROJECT ADDRESS <br /> / p � �, <br /> �V'Dr)r� lJUI� "�'!''S <br /> Owner t.1�il Address City Slate2ip phone <br /> Tenan� p1ail Address City / State�/Z7ip Phone <br /> (� /` �D�� / /� \ / c7 / <br /> �e�,�•y � S C�rc�1��L � C�� (Ja� �02'1 U Sr�Uc.<tc, h/�1 13601��/-69/� <br /> Eleclric2l onlraclor Mail Address City StalelZip phone <br /> �E�rR�,fi� ���l� nN � , ;�� _, � <br /> S�ale License Number CoNracl Price of bVork <br /> Sft1 � Le f�"�R �itr �� �i!S/G�!���'� <br /> Propose Use of Duilding Contacl Person (Plan Review) <br /> Descrip�ion of Work lo Be Done: lv� 1� ! l�i�f �V �1 U d� -' �00 ��r� $f�li!C-f� <br /> NOTE: WIRING IN NON-DW[LLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> %% � <br /> CITY OF EVER[TT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby ceriily Ifrat I have read and examined fhis applicalion and know the same lo be Vue and <br /> correcL All provisions o!/a�vs and o�dinances governmg this fype ol�vork will be compl�ted <br /> n�hefhcr specdied hercin or not. The�ran!ing o/a perrnd does not resume to give�uthonfy to <br /> violafe or cance/fhe provisions ol an}�otha�sfate or local law reguPting constnicfion or the <br /> peiiormance oI cons(ruction. Thaf I am aufhorized by the o�vner ol(hs property to pe�forrn the <br /> work lor which application is niade and I comply wilh the Stafe Contraclers La�v 78.27 RCIh�and <br /> 29G200 INAC. <br /> F,' l� fy r <br /> �\ �t.�� ,` -1�:1t 3 /-0 � <br /> �5ignature � Dale <br /> � <br /> F� �r' �'_ � �� - <br />