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l � <br /> ELEC <br /> TRICAL PERMIT APPLICATION I' <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 8 AM TO 4 PM - DEBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> ZI � Q Man►�a� �v� . <br /> PROJECT ADDRESS <br /> i���c I�+ Tharn a r 2n9 Mon�o�� Av��. � v�rett �v�. � ��o� <br /> � Cily SIa1MZip Phone <br /> (]wner Mail�ddiess I„1�_ u 7� _'D(LLl_ <br /> �f� T � T <br /> �V/� <br /> SlatclZip Phone <br /> Ten2nt Mail Address �'�Y I <br /> Li�n�e� E� C�<fri�( SC�vi�C' I'�i�59 N� �� fih S��-. �G�IIeV���, �UA . ��K00� <br /> � Phone <br /> Eleclrical Conlraclor A1ail�tld�ess � City Staic2 p 2 ��_i77� <br /> � '�00. 00 � � <br /> LAND � t �' R�1113C � , I�I�'z > � <br /> State License Number L <br /> Conlracl Price of Work <br /> �fl nq�c� f�M���� _ iu�� � n i�n�lnn <br /> Propos d Use of�uddmg/ ontact rson (Plan Review) <br /> Descriplion of Work lo Be Done�. <br /> �h(!' G1 �� � �0<aM� �(1�<u-I r'� <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. �j� O� <br /> / I <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 5105 <br /> I hereby certi`y fhaf I have read and examined this t�Pp�icafion and knotv Ihe sante to be In�e and <br /> coirecL All provisions o�laws and ordmances governmg fhis type oI�vo�k n�ill be wrnpleted <br /> �vhether spec:lied herein or not The granfing o!a pemut does nol piesume lo groc authority to <br /> violafe o�can:;el fho provisions of any ofher stafe or local Imv regulating consfruchon o�Ihe <br /> performance o!conshuchon. That I am aufhonzed by the o�vner o/tlus property fo perform the <br /> �vork/o�which applicafion rs mado and I compty wifh fho Stafo Confracfcrs!a�v 18.27 RC W anA <br /> 296.200 WAC. <br /> j ,�I��l `�� I � - 05 <br /> S�.ynaWre ' Uate <br /> � oS�R-I(� ( <br />