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ELECTRICAL PEi�MIT 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 /> � <br /> � <br /> �lC' � ,����'�L�'l'����' �Jt � JE��f ,Gl'�'� <br /> PROJECT ADDRESS <br /> " `"� � L il'(C�j � �" �) <br /> _('��,�G� � � /l�'� ,��D��1C-'�1'�K'✓f1JP �JE'�f'17 [v'� 15,�G1 `/�5�,15� Li/%� <br /> O���ner latail Address Clty StatelZip Phene <br /> Tenant L7ail Address Cily Slale/Zip Phone <br /> ��.�� � — <br /> Electrical Contraclor ldail Addiess City Stale!Zip Phune <br /> State License Number ConUacl Prico ol Wor4: <br /> Proposed Use o(Building Conlacl Person (Plan Review) <br /> Descriptiono(WorkloBoDone: �!�rbLN/� � l('L�l /�l D��/7 �U� l.�/1/J.� <br /> � <br /> NOTE: W IRING IN NON-D�VELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAI'S, MC OR AC CABLE. <br /> � CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby ce�tify tliaf 1 fiave read and exarnined this application end kno�r fhe sanie to be true ana <br /> convcL A/l provisions ollaws and ordinances_oo��ert�mg this fype ol work will be completed <br /> u�hether specdied herein or noL The grunfin�ol a pennd does nof�resume to give au(honfy to <br /> violate or cancel tho provisions of any ofher state or lucal la�r rec�u t+ting construction or the <br /> pe�forrnance o/constniction. That 1 am autho�ized b}�fhe owner o/fhis properly to perfonn fhe <br /> �vork lor�vhich application is made and 1 comply�rifh the Stafe Conhacfors La�v 1t3.27 RCIt�mid <br /> 296.200 lNA C. <br /> {i <br /> �� � � � ��.1,�7 ��, �1���/-' �'�� � � �_ 7 <br /> h 1 /� � i�,J ��, , „ <br /> Sipn ituie ��� � Dal � ���-' � <br /> � <br />