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ELECTRIGAL PERMIT APPLICATI�►N <br /> CITY 01= EVERETT PERMIT SERVICES <br /> 3200 CEDAR STRFET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX425-257-8857 -www.everettwa.org /a -J�/�/Z <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM L%��'�� -�/� <br /> 6 3 C� /�'�c�Q,e r� c�e Gc /��,.a�i�w� <br /> PROJECT ADDRESS <br /> CJ�-s(�rv �-o� , ��r <br /> Owner AfadAddress City S1alelZip Phone <br /> Z o�P;�4� <br /> Tenanl AtailACdress Gty SlatelZip Phone i <br /> .�SS�cr,�.Q-�� E!e�tr� �J cT�sX Zb�c7 S.u��r�liS (.-Il/� 58�9/ f1S- 33y-�y�5� <br /> ElectriCal CoNrac�or ldail Addiass City State.�Zio Phone <br /> �SSac.c'c. o8$ Nt- $ !r`� vu`� � <br /> State License Number Con�racl Pric of Work <br /> Osr�f�. / `., t� �a� e <br /> Proposed Use f Building Conlact Person (Plan Review) <br /> Square Footage Qf residenlial new conslruction, remodel or addition) <br /> Descriplion of VVork to Be Done: � F� kto�� /"ei"� �`�"^�"" ' v"�• '"""' <br /> NOTE: WIRING IN NON-DW[LLINGS IS REQUIR[D TO FEE 'l <br /> BE IN RACEWAYS, MC OR AC CA�LE . �O�Q�/ <br /> CI7 Y OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerfily that 1 have read and exarnined(his a.nplicafion and kno�v fhe sarne to 6e lrue and � I� I� _ ��� <br /> coriecL All provisrons o/latvs and o�dinances governmg lh�s type o/n�ork will 6e complefed <br /> whether specifred hcrein arnoC Thc g�anling ol a pem�it docs not resumc fo give aull:odty ro <br /> viola(e orcancel U�e provisions of any other sfafe orlocalla�v reguP(ing construcfion or Ne <br /> perlonnance o/cons(n�ction Thaf 1 am aulhonzed by the o�•mer oRhis raperfy to perfomi Ihe <br /> work(or�vhich applicafion is made and 1 corrioty r�itii the State ConfracPrs Lav� 782'RCW and <br /> 296.200 WAC. <br /> �,( � /��/��z <br /> ignature Uale <br />