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( <br /> ELECTRICAL PERMIT APPLICATIO►N <br /> CITY OF EVERETT PERMIT SERVtCES l� _ o8�i0 <br /> 3200 CEDAR STREET, EVERETT, WA 98201 �/O// �3-I <br /> 425-257-8810 - FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> (�oo /`1er��l� �re�l� ��:.rl�� <br /> PROJECT ADDRESS <br /> U11��s6.Z�'�-�n �cl�Fu+� (,nr�� LI..L 6G�o.av�rs,4��S�-. so'� �e 2�zv Se�.�le uA�/9��°� _ <br /> Owner Mail Addross Ciry Slate/Zip Phone <br /> ��0.�2��'e�'�'f-oni cs 63� �.�rr<I� c�e�lcp�k� ��u�tf' W�/ 98Lo3 <br /> Tenant Mail Address City Staterzip Phone <br /> �cCepi����-� �ie�N-'�c�l �qo;3al.rul'c., DLSE�32f Mo,�rc� w�/q�Z �-z yzs-3i4-�-�ts� <br /> Eleclrical Conlractor Mail Address City Staterzip Phone <br /> �,rc��E I ql3 CSb S o00 <br /> State Lfcense Number Contract Price ot Work <br /> 01�'�c� SPitc� � <br /> Proposed Use of Buildfng Conlact Person (Plan Review) <br /> Descriplion of Work to Bo Dono: ��5��� � � ��"�� /"`aK� �terM051�-� � <br /> ��11-� �� 13 Q,t.r��?e� �cfU4�'�� Lo�t'f-r'o(5 <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> G�TY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby cerfily that 1 have read and examined this application and know the same to be(rue and <br /> correcL All provisions of la�vs and ordinances goveming this type of work will be comploted <br /> whefher specified herein or not The granting of n pemuf does nofp resume fo give authonty to <br /> violafeorcancelffie Provisionsofanyotl�erstateorlocallawregu/atingconstrucfionortho <br /> per(omiance of constructlon. Thaf 1 am authonzed by the owner of this�roperty fo peAorm the O�� <br /> work tor which applicntion 1 do and 1 comply wifh the Sfate Conhacfors Law 18.27 RCW and <br /> 296.20 AC. ,�_ <br /> � /�iRti�� : ��.� II/S/LD(O '�I1 . <br /> I <br /> SlgnaWre Dale <br />