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ELECTRICAL PERMIT APPLICATI�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-9�10 - FAX 425-257-8857 — w�w�.everethva.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 Ah7 TO 4 PM <br /> ao31 l� ap�e, S�- , (- ��r�-� wk q8r.�� <br /> , <br /> PROJECT ADDRES <br /> 26� - <br /> e�� so�fn �-03� �l,dc.� E��v�- W t� �5�o, 3► 6-�-st 3 <br /> Otvner ldail Address Cdy State/Zip Phone <br /> � �'C 1 <br /> Tenanl btail Address City Slate/Zip Phonc <br /> �W�� <br /> ElCctrical COn�r�tto� b-0ail Address City Slate/Zip Phone <br /> �� � <br /> Slate License Number Contra.l price of Work <br /> � � ��,� � <br /> �,� <br /> Proposed Use of 6uilAing Contact Person (Plan Revie�v) <br /> Description of Wort: to�a Oone: r�-' �OJt� �yi,�b p �� W�r�i Ca Q�q-e 2 ...� �,� _ <br /> --�I f /� 1 <br /> Win. e ec+fl�nX 2�1 K.eQ • --- <br /> NOT[: WIRING IN NON-DW[LLINGS IS REQUIRGD TO FEE <br /> QE IN RAC[V��AYS, MC OR AC CA9L[. <br /> GITY OF[VERETT LOCAL SAIES TAX CODE IS 3105 �v <br /> � ar�a <br /> 1 heieby certily fh��f f hav�read and exarnined this applicatiun and kno�v tha same!o br�frue and � <br /> eor��ect. All pwws�ons ullaws and ordinances go��ernmy fhis fype of werk�vill be cornpleteU <br /> whether spe„dieAherein or nuL The�ranhng oI a pe�md does nof �resume to give authenly to <br /> vio/afe or cancel fhe provisions of any ot�,er stafe or loca!Imv regulafing cons(�uction or fhe <br /> pe�lom�ance o/cons�rucfion. Thaf I am aufho�ized b}�the o�vner ollhis properiy to perlonn fhe <br /> wo�k�oi�rhich applicafion is mado and!comply�vilb 16c State Conl+acfors Lau� 18 27 RCIY anA <br /> 296.200 11�AC. <br /> —�C� � � _ <br /> � l3 Zd�2 <br /> Signalure Dal� <br />