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1,1as� , 10 . ?OOf� l :rnpt, i�GH�;� Sv"sT�l�1�g IIlC IJo. �gy0 � 1 <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SEFtVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857—www.everettwa.org <br /> APPUCATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> �' �l(� l nt��rztLL �i�l� �ku,�,�.y l�.y # �� <br /> PROJECT ADDRE3S ' <br /> �Lr �(� �� /��'Y�Q1�11 C._.�/�V GtlUCVI Wl� <br /> Owner Mail Addres City Sate2lp Phone <br /> Tenant MallAddrose Clry statemp Phone <br /> "f'�C�IvA- �Y51 E�kS :.�h►C ►'1'lccrvsUl � ��P (.u�4- '361J�S^��s"%�/ <br /> Elecuical Conlraaor Msll Address aty &wte2lp Pnone <br /> T,FCt�NST �'k�/N�_ � .7c9u. o0 <br /> State License Number ConVact Prica of Work <br /> n'lUl F�m�.�.N <br /> Proposed Use of Bullding Contact Person (Plan Review) <br /> Descrlptlon of Work ta Be Done: �(!'� � 1�VL2/Yt-� .L/!1 �1?'cK�J <br /> NOTE: WIRING IN NON•DWELLINGS IS REQUIRED 70 FEE <br /> BE IN RACEWAYS, MC OR AC CAeLE, <br /> CITY OF EVERETT LOCAL 9ALE3 TAX CODE IS 3105 <br /> 1 hereby cerilly that 1 have�eed end exomined ihls epp11ca0on and know the same to be true end <br /> consct. All provisions ollaws end o+dlnances goveming thls type of work will be ccmpfeted � <br /> whether speci(ed hereln or not. The grsnfing o(e permit does nof prosume to pfve autlforlry!o � � <br /> vfolatecrcaneelthe provlslonsofanyothersfeteorlccallawregWatlnqconstrucflonorthe / �5 D <br /> performance o/construction. That I am authorized by the owner ol thls property to perform fhe rn�(7 <br /> work for whlch application Is made ond 1 comply wlth the Steto Con;recto�s Law 18.27 RCW and �" <br /> 296.200 WAC. <br /> . , <br /> � s o- . � <br /> SIGnaNre oia � <br /> �1 �2CesE' L�cF'..� ,�e�- Q�c c�f C1,��e 3 b v �o s - yy <br /> .se.. �-x r►m` ��- 3,60 -(aS3 - �7SE� <br />