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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 <br /> APPLICATIONS ARE ACCEPTED FROM S AM TO 4 PM - DEBIT&CREDIT CARDS ARE NOT ACCEPTEU <br /> �; �3 no 11�1 �.�^L,: � I I C�; ��. k ��<i� ���=��,�� � ����f � + wq <br /> PROJECT ADDRESS <br /> , vt 2 :S.�o <br /> � aL- 61_ - <br /> ����:�5i,�.,�a �r:, («�;i Sf <br /> / I 1 ��co u�� � v. 5��:�I��L u/.4 r�io� s ���,s <br /> {,'�l-i.\L ��c�ln } <br /> Ownef MailAddress �A Cily StatelZip Phone <br /> �1- 7"' <br /> `f„- i- <br /> z��w� i � 'L 1 `!� v xU�-" J4-. �ic,� G�r.�4t f� �v/� l��v3 isci <br /> Tenar,t MailAddress City SlatefZip Phone <br /> L.}"� �'���- k' `( <br /> � � ��Juv�„�� I? 31G., l3 t — C�4, �4r' �<<[i�� ���,�i c���l `j8C`�5� E��c�c <br /> ElectricalContractor MailAddress City SlatelZip Phone <br /> _� � � ��C- � c- j 'l � S' `i � (5, oo��, , <br /> State License Number Contract Price o(Work <br /> Proposed Use of Building Contact Person (Plan Review) <br /> L,j�W 1�G5 �t ii �� C 4't�� `L �1 c'l(� -t f �S J.1��:c)i.i f`� <br /> Description oF Work to Be Done: � <br /> Ci�� �� � nar, f��,.�� � �Z 5 . <br /> NOTE: WIRING IN NON-DWELLINGS IS RE�UIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> � <br /> � CITY OF EVERETT LOCAL SALES TAX CODE IS�105 <br /> f <br /> �. 1 hereby certify thaf I havo read and examined fhis applicalion and knn�.v fhe same fo be frue and <br /> conecG All proviswns o/lsws and ordinancos govommg fhis rype o!�vork�vill6e comp/eted <br /> whether specified herein or noL The granfing oI a pomut does nof res,�me to give authonly to <br /> violateorcancellho provisionsofanyofhersfafeorlocallawreguPtingconsfn�ctionorlhe <br /> performance of conslrucfion. That 1 am authonzed by the owner o/fhis property fo perform fho <br /> work Ior which applicafion is made and 1 comply wdh fhe Sfafe Con(racrors Law 18.27 RC W and <br /> 296200 WAC. <br /> 1 .---�� .%l \ l "� �L c�L�l� // " ( l - :.� <br /> . . � ` ��! <br /> SipnaWre Date <br /> ��YI�I-b�d <br />