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ELECTRICAL PERMIT APPLICATI�N <br /> CITY OF EVERETT PERMIT SERVIC�S <br /> 32J0 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 47.5-257-8857 —v,rvw.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ��O� —O(� <br /> � � C� Ei0 / —O �'7 <br /> c��� , � �� � �� n,1 ��� E"'Ll�) �) � l,'l� i <br /> PROJECT ADDRESS <br /> i � �+ <br /> . �%c); � + 1 ^ � � �� --r !�� "' �� V v' L'�t��� /✓ (t,'l� . 1 L'r2 a[ �7� G�'/� `%�c�l� 3 <br /> _ �` t�/ ; _ t'1 i. �' � il L)�'� � <br /> Owner �dail Address Cily Slate/Zip Phone <br /> Tenanl MailAddres; Cily StateRip �oneF <br /> p C. '` <br /> �l�''�rl�l�� ��� �Z��/�'' i� �, 1� •U� ��c>� `��� ��Vl,,�n�,� 5 Ll��� 3u �: <br /> Eledrical Contrac?or A7ail Addmss Cily State/�ip ���r� LPhone <br /> � � ��� � <br /> y�� �: ;=���. E l'U`� �7 � V✓ I <br /> State License Number Contract Price ot Work <br /> Proposed Use ot Building Conlact Person (Plan Zeview) <br /> Description ot WorY,to Be Done: <br /> ^�l �. �f'y1/� �.Q� 1i i (�J_ ���9/1/lF�/'— <br /> 1 <br /> NOTE: WIRING IN IJON-DWELLINGS IS REQUIRED TO FEE <br /> BE W RACEWAYS, MC OR AC CABLE. <br /> _J <br /> CITY OF EVERETT LOCAL SAIES TAX CODE IS 3105 <br /> I hereby certi(y that I h�ve read and examined this applicafi�n and know Ihe sarne to be tn�e and <br /> correct Afl provisions ol laws and crdinances governmy this fype o!work will be complefed <br /> �vhether specdieJ herein or noL The t�rantiny o/a pernut docs nof precume fo gi��e .ufhonty fo <br /> violate or cance!fhe I�rov:sion�o/any other sfale or local law regulatirg construclion or Ihe <br /> pe�forniance o!consfruction. Thaf 1 am aulhorized b} the owner o/fhis property fo perfomi Ihe <br /> work lor�ahich application is made and 1 comply wifh�he Sfate Cnntractors La�ti� 18.27 RCl4�and <br /> 29G200 WAC. <br /> n <br /> I� ,�? ��"�,,C���.-� r �•ti I '_ �-_ C�' L, <br /> �pnature Date <br /> /�('' / - % <br />