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� �- �4� Y— �/9 � <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 /> (, G .�9 C�l.�n,�j,G �C/.-,��' — <br /> PROJECT ADDRESS <br /> Ki�itEN �^o".N SGZo /o0 "��N.� /f'J,aQy3v���� 1/�A �Z70 3G0-GSb'- O /� <br /> Owne� hlail AOtlress Cdy� State/Zip Phonc <br /> Tenan� MailAdtlress City State2ip Phone <br /> ilc e�s�c � �c`c� � {�c �`�yZU �7t�C.. �v�. ��. .S.v:�St.+.is�� lc%q 9fZ96 <br /> Electrical ConUactor Maii Address City State2�p Phone <br /> � <br /> �o.^t,C Fc' 09� �f�- %.� oo. �•o <br /> State Ucense Number Coniract Pnce of Work <br /> dvB ,�oc 39/-02�c�! <br /> rw f <br /> Propo d Use of Budding Conlact Person (Plan Review) <br /> Description of Work to Be Done�. �- �UO y'i.�- S�/(//�C <br /> 07 - /uo �i.�A Frc�r�Z,.S ' <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certdy fhaf 1 have read and e��amineA this applrcafron�nd know fhe same lo be frue and <br /> �urrecf. Ali provisrons ol laivs and ordmonces govemm9 Ihis(ype o/worN wdl be complefed <br /> �vhelher specJieAherein or not. The g�2nling o/a pennR does not presume fo give aufhonty to <br /> violale or cancel!Ne prnvisions o(any other stafe or local law regulafing consl�uction or the <br /> perlonnance o/consiruchon. Thaf/am authoiized by the orvner o!fhis property fo pedorm the <br /> �rork lor�rlrrch appbca(ion is ntade and 1 comply tvrth!he S�ate Confroctors La�v 78 27 RCW and <br /> 296.200 W/AJC. <br /> //N������� ��/j^OL <br /> � Sipnatum Dale <br /> �rhD��'�i�L{ <br />