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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 8 AM TO 4 PM � _ '3 �D� <br /> V«� <br /> , �J <br /> `jG1c L� /��ci��.1.c ' �iL� '� <br /> PROJECT ADDRESS <br /> <� 1 \�7 C, <br /> ,('ii�llV ��01� 4VYd.V'll'l ���� � �� IGi it� �j'i�l� ' Jh '� � �CG:n'C_��,� �1t� /��i:J � <br /> Owner ✓ Mail Address Cily Stale2ip Phone <br /> Tenanl 61ai1 AAdmss City Stale2ip Phone <br /> i <br /> � 1 P�jy�) � r J¢ I�)�7uU '`�� =�L� gT q /b`� �} �/�tiwi (;?1 `7'���t>S <br /> Eiectrical Conlraclor Mail Address Cily Slale2ip Phune <br /> ��lS��'t5� ���,�n� ,3 � IU,c�C; ! <br /> Stale License Number Conlract Frico oFWork <br /> �� <br /> �� ,n �� � �����,� /7�,���� I���.,.�, <br /> Froposed Use of Building Conlacl Person (Plan Review) <br /> Description of Work lo Be Done: ]� I(Y� Q t��f� I�LlUS ('i��C�1 `�.L'�� C2«I� i ti�+� t�-'i /d�l�l/� �S <br /> 7t-v M2'�L't�4� �1 r <br /> � <br /> �{ �Kn�J��P�C <br /> NOTE: WIRING IN NON-DWELLINGS IS R[QUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CI7Y OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certify thaf 1 have read and examined fhis application and know fhe same to be hue and <br /> correct. All provisions ollaws and ordinances govemmg this fype ol wori;will be complefed <br /> whefher spealred herein or noL The granfing of a pemut does nof resurne to givc aufhonty to <br /> viofafe or cancel fhe provisions of any other sfafe orlocallaw reguPfing consfniction or the <br /> peAornrance o(consWCGon. That I am authonzed by fhe o�vner of this property to perlomi the <br /> u•ork lor u�liich application is made and 1 cornpty with fha State Contractas Law 18.27 RCW and <br /> 296.200 WAC. <br /> �__ ----� �/ <br /> --�"�„'��� a�o[., <br /> !—�igna[ure ---------- - Dale <br /> �171➢d�J 'Q��� . <br />