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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 <br /> 1Z - �� -b7 <br /> � p7 � 2 �U�] <br /> � � � � �1 'I 1=-�" \1(r'�1'l- <br /> � <br /> PROJECT ADDRESS <br /> �75 - 3S - <br /> 5��= �(c��i�-'�"1 L S r� �7 iJ f�1N �- s��� Z�a i��l l c w 4 � �� � <br /> Owncr fdailAddress City State/Zip G�Ysd�-� Phone <br /> / <br /> Tenanl 61ai1 Address Ciry Stale/Zip Phone <br /> V'Payrr.(( I i i ��r�� i ��~ 5,- 5� c�"�►T ��' `t�Z�'rS `r �5' -3� � �5- p <br /> Electrical Conlractor � A1ail Address City State2ip Phone <br /> ��c� �_ �_ �i�� k � -��oa = <br /> Stale License Nwnber Contract Price ol Work <br /> �'�7�JI?0 5 <br /> Proposed Use cf Buiiding Contacl Person (Plan Review) <br /> DescriplionofWorkloBeDone: (�'(..���'7ZaL'YL �(�+i% �F L01�`-' vG�'7 l.�f'-I^��✓ ��' �1�`1'�' <br /> CC�1��1 <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED T(� FEE <br /> BE IN RF.CEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby certily fhaf I have iead and examined fhis applicafion and know fhe sanie fo be hue and <br /> correct. All provisions ollaws and ordinnnces govermng this type ol�vork�rill be completed <br /> whether spea6ed hr.�ein or noL The granling oI a pe.mut does not presunie fo give aufhonfy to <br /> vio/ale or cancel the I�rovisions o/an}�other sfafe or loc,�l la�v regulating cunsVucfion or the <br /> performance o/consfrucfron. That I am authorized 'uy the owner o/th�s property fo perlorm fhe � <br /> work lor which applicefion is rnade and 1 comply wifh ihe Stafe Contracfors Law 18.27 RCIN and � <br /> 296.200 WAC. �, 1 � <br /> l�-� � � � ;''� � � / �� <br /> `;-; �,�,- �� � r;l - i z -�� �-�- �� <br /> , Signatur� Dale <br />