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ELECTRIrAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-885'—w�nva.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> � i'� � ���� ��-���/�� <br /> PROJECT ADDRESS <br /> �2r, --.;��i 7.5�%i`i' <br /> .��i�5� �o �f � /.�� ��� c�/���i4�t� ����o,>�� �i� y���72 v <br /> Owner jrt� Address Gry State/Zip Phone <br /> ✓ <br /> _�`'�-e <br /> Tenar.t Mall Address Cily Sta�e/Zip Phone <br /> r� <br /> � �U l� �5�� i^✓,� � �, . <br /> � <br /> [leetrical Contraclor ntaii nddress city state!Z�p �none <br /> Slale License Number Contracl Pricc of Work <br /> � / <br /> ��Si�7 rs�' 7 4�19� ��P <br /> Proposod se of Building — Contact Persen (Plan Review) <br /> Description of Work lo �e Done: �7CC��i�� �/4' ,��� �/'J�����.P / <br /> '1 Q�' � t' Ili" �fJ� �Lf19�.��� 1' <br /> NOT[: W IRING IN NOiv-DW ELLINGS IS REQUIRFD TO FEE <br /> BE IN RACEWAI'S, MC OR AC CABLE. <br /> CITY OF EVERETT LOCHL SALES TAX CODE IS 3105 <br /> I hereby certi/y thaf 1 have �ead nnd exanrned this ap��'ic��fion and Fno�v fhe sarne fu be Vue and <br /> corr'ecL All provisions o(laws und ordinances gaveitung fhis type al�rork�rill6e comp/eted <br /> whether specilied herein or noL The granting u(a pennR does nof resume to gi��e authonty(o <br /> v�olate or canc�l the I�rovisions ol any other stafe orlccal law reguPting consfrucfion orthe <br /> perfonnance olconsfruction. That I arn aufhorized by the o�rner ollhis property to peAorm fhe <br /> work lor�vhich application is m��de and 1 comply�rith;he State Cenfractors La�v 18.27 RCl1�and <br /> 296.200 WAC. <br /> ;•� <br /> -K-.4�� l /' :`� � ` `.�;1. — � � <br /> . r � <br /> Signalme Date —` <br /> 1 ' I <br />