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ELECTRI�AL PERMIT APPLICATION <br /> CITY OF F_VERETT 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 <br /> a a c� 2 rYIonJ2v�c. �+ ✓� <br /> PROJECT ADDRESS <br /> G✓/LL/R �'1 Aa A;GPc'Alc 22a2 rr�aN�o�- �vG lvrrtrT �✓a- cJ � o3 /1/� <br /> ( Owner Mail Address City Slate/Zip Phone <br /> Ten�nt Mail Address City Stalel2ip Phone <br /> - 4-2/3�:��- �i,Nr L-'LE!?n'.ic T-nir. (o4ZFS -/��r n'ST St_J /_yNNwoy.o C�fr 98�`3 7 '�Zr'-JyL `/6 <br /> Elecirical Contra^.tor Mail Address Ciry Sla�e/Zip Phone <br /> a, o � �;�f� aP �soo. a ,� <br /> State License Nurober Coniracl Price of Work <br /> Proposed Use of Building Conlact Person (Plan Review) <br /> Descriplion at Work to Oe Done: �'l�J �O D !f iv� f' �«-�! fj/2I �. <br /> rt,�.�.r�,,t, GJra sN�� �D,^y e� L:rzc v� � <br /> NOTE: WIRING IN NON-DWELLIPJGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETI LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby certily Ihat I Imve read and examined this applicafion and know the same to be We and <br /> conect. All provisions ol la�vs and ordinances govenunq this type oI work will be cornpleted <br /> �vheflier specilied herein or not. The�ranting ol a pernuf does not p�esume to give aufhonty fo <br /> violate or cancel fhe��rovisions of any olher slafe or local law regulating construcfion or fhe <br /> pedorrnance o/cons rucfion. Thaf I am aufhorized by Ihe owner ol fh�s property fo perform fhe <br /> �vork for u�hich application is made and 1 cornp/y�vith fhe Stafe Contr<�ctors Law 18.27 RCW and <br /> 296.200 WAC. <br /> /�'� � �i' <br /> /l'�c,�_ � , (/�?cJ�� <br /> ' Sic�nature Date <br /> ��'�,/ _ ? � <br /> � � <br />