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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 � �_31../',L <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �/�'�'Z `�7� <br /> ��Db p R ss ri I1 GYe�. � Purkw�� <br /> � � l� �ocQ,��a � I 2S I D sfi�t-f-� /f-v-e , C�'tav�sV��l(�,, W�- �8 Z 7 / <br /> Owner MaJ AdOress Ciry SlatelLp Phone <br /> �Ai� c,h�vspdc�- �3��0 ��rr��ll cveeV� Qarkwa � �t�e-r�� 1N� ��3203 <br /> Tenant Mail Addmss Ciry � StatclZ�p / Phonc <br /> l�.t'�') ��� ` <br /> HeV��nav�s�h (',rX�z�1� �� 1 �21 2� � N� �ev��f, U�/�1 9P�a �,2 ��� oo <br /> Elednc3l Contractor d Atltlress Ciry SlalelZip Phone <br /> H�R-Ma-� � � � S �DK � � �Zs� <br /> Slate Ucense Number Contrect Price o(Work <br /> �ac�l�QG ��2 space — Cvm�ru,rc� a/ I'� rS fe vt Fu uS� <br /> Pmposed Use of Buildmg Contad Person (Plan Review) <br /> N lf� <br /> Square otage pf res�dential new construction, remodel or addilion) <br /> Descriptian of Work to Be Done: �� � � nQ� I /lL�r11��51 �[ I � Gt-�D U� {'I�� <br /> d nr,� o V� � �) v�l�r a-f-e.� �1'�1e v rvw sl-�t �(vu►� a n e x r.5� <br /> o�-fu �t v� f {- - <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FE� <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> �p • oo <br /> CITY OF E�r'ERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hemby certity fhaf 1 have read and ezamined fhis app�ication and know tho same fo be tn�e and — a,a - i � o <br /> cormcf. All pmvisions ollaws and ordinances govemmg fhis type o!work wdl be complefed C I <br /> whelher specified he�e�n o�not. The granting o�a permd does nof resume lo g�ve aulhonfy lo <br /> violale oi canrellhe provisions ol any ofher stafe orlocal law reguPlmg consUuc6on or Ihe <br /> peAormance o/rnnsirucfion. Thaf 1 am aufhonzed by fhe owner ol Ihis properfy fo perlorm the <br /> work Por�vh�r,h application is made and 1 comply wifh fhe Slafe Confractors Law 18 27 RC W and <br /> 296 200 WAC. <br /> �-,�f=-d ��',C�ec._ � 2/�i�/ZO � Z <br /> Signature Date <br />