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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 425-25%-8857-�!vww.everettwa.org -, �as -�3 <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � � 30"�--� �', <br /> ��� ,�� � � <br /> L. � �� l� � �� I ' C� <br /> PROJECT ADDRESS � <br /> i ,, � �J -,.� � <br /> /J� / 5 , t < < </�L/�/ ,�'�/,r����'(� e �����r�-t, /:ff /,�_���— <br /> . � <br /> Q�ef MailAddress Qt� State/Zip Phrne <br /> ZD(• -'�s J <br /> � �� Phone <br /> TeneOt Mail Address City State/Zip <br /> ,C t� r � / / � ..t � �� <br /> !1 i �� [ !'�' /�-7 � ! �li !t'S��/'Jc_ lC�S - t�r��h�= /f,C'�//�c'iC.. /Jl�7 r Ph�e .� <br /> Electrical ContraCtof Mail Aadress C�ry StatelZ�p �; � <br /> ��'�F'3�-7�/� <br /> �- �f <br /> �� �� ��`� � � Contract Price of W <br /> State License Number <br /> S �j ��� <br /> Proposed Use ot Building Contad Person (Plan Rt�view) <br /> Descnption of Work to Be Done: f,� � f�ir�� t' y� �' '¢ti��� `r ������l' <br /> /�i/� /N ^ c !'/�.l� Y"r �C S h �.� !-?-'✓ '�` �t f�tt-� �• 'rr. l'I <br /> —r�-"'�_' T— <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. ��C� �"..�� <br /> CITY OF EVERtTT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certify Rtiat I have read and examined this application and know the same to be true and � � " < "� � <br /> 7�.'a � <br /> correcc All provisions ollaws and ordinances govemmg this type o/work wtll be completed �; �_ ' �� <br /> �vhether spea�ed herein or noL The granfing o(a permrt does not presume to give authonty to <br /> violate or cance/fhe rovisons ol any otherstate or local law regu/ating construchon orthe <br /> performance olconsPruction. That I am authonzed.by the owner oI this propeRy ro perform fhe <br /> work for which applica�ion is mede and I compty wrth fhe State Conhactors Law 78.27 RCW and <br /> 296.200 WAC. <br /> � Q..� ��-`�,� C � -�-'S -� 5 _ <br /> Signature Date <br />