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ELECTRICAL PERMIT APPLICATlON <br /> CITY OF EV�RETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-88;0 - FAX 425-257-8857-www.evereltwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> �%"/-�� /�.��/,//� >�C / KG?,4 ./ ��L�`E ��J <br /> PROJECT ADDRESS <br /> i � Q �/ _/ �� / / �,,� <br /> � �� � �L�l'�JD./J91�'�.���� /. �Y�TD�" "70�,��v�' G� Ju��G J"�� �(�/N�.�tr�i�/sQS� <br /> Owner MailAddress City State2ipi/�':��.�,,�� Phone <br /> 7 <br /> Tenant Mail Address City Stale2ip Phone <br /> �If ��ki���.� Cl�ct �l�� r_ /�.3c�� ._�'v�-'-�✓���� 4� G'�cfa,i�,v�/s� ;��o:�� <br /> Eleclrical CoNracto Mail Address City State2ip��:�3.7��� Phone <br /> `��JC'.f�NG;/v'>� � �/ ���?. G'� <br /> Stale License Number Contrac Price of Work <br /> � ��' , ,/�`/� �,.S� <br /> Pr osed Use o Building C:, dacl Person (Plan Review) <br /> Descriplion o(Work lo Be Done: (.� �L�' /�l'�t, � C�-��.� G 7"V/NS'�� <br /> NOTE: WIRING IN NON-DWELIINGS IS REQUIRED TO FEE <br /> 8E IN RACEWAYS, MC OR AC CABLE. <br /> �� �� <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby certily Ihat 1 have read and exarnined Ihis applicafion and know fhe same to be true and <br /> correct. All provisions olla�vs and ordinances govemin�fhis type o/worh will be complefe� <br /> whefher specilied berein or noL The r�ianting o/a permd does not presume fo give aufhonty to <br /> violafe ercancel the Provisions o/any ofhersfale orlocal lawregulafing construc6on orfhe <br /> performance ol consfrucfion. That 1 am authorized by fhe owner o/this property fo peAorm ihe <br /> work lor wbich applicafion is rn2de and 1 comply wifh the Sfafe Confracfors Law 18.27 RCW and <br /> 29G.200 WAC. <br /> -,,- �l <br /> C. �,,r � ��, � - <br /> � Cl.� z � / G�tocc. /b - 3• D$� � �� <br /> SignaWre Date -�� <br /> r"i J - �?� % <br />