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( <br /> 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 /> � St <br /> C' �'-j C /' U/� <br /> PROJECT ADDRESS <br /> ,2 ��/-lG� ��l�c $c� <br /> v, f � <br /> � <br /> .l�i� ��r-i'�,U � /e-'� 5 ��� �L� ;�/�,Z �j.�a �/ <br /> Owt1Cf ' Lin�l Atldmss Gly Slate/Zlp Phonc <br /> /���k'C <br /> Tenanl 1.1ai1 Addiess Cily Stale/Zip Phone <br /> [Iectrical ConlraClof Mail Address Ciry State/Zip Phone <br /> T���,; <br /> _� <br /> Slale License Number Con�ract Price of Work <br /> i ) <br /> � /:'l>,%-��'i'�C�.i �/ �it>Gi1T�—. <br /> Proposed Use ol Building Conlacl Person (Plan Review) <br /> Descriplion of Work to Be Done: /U,,7r� li+v�,��'.`/�"�.i `�/�/S/��a� ��izyr... `���.� <br /> �/ .�C� ��'� �,.�'i'i��c� - L�1��ti % lLe,r-/� ����' S �Z �iJ� J <br /> � ,i r'� <br /> NOTE: WIRING IN NON-DWELLINGS IS R[QUIRED TO FEE <br /> BE IN RACEWAYS. MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS �105 <br /> 1 hereUy cedily fh:.!I have read and exarnineAfhis application and 6no�+�(he sarne fo be frue and <br /> r.orrecL All p�uvisions ollaws and ordinances governinr�Ihis type ol�rork�rill be complefed <br /> �vhefher spea/ied herein or noL The granfing ol a pwnu(does nof�nesurne to give authority to <br /> viclate or cancel ihe�novisions ol any other sfate or loca/law rcgulafing consfruclion or fhe <br /> perlornmnce o/cons rucfion. That I am aulhor'ized by fhe owner o�Ihrs property fo pedorm fhe <br /> wcrk Jo�which applicafion is maAe and I comply with the State Contractors Lau� 78.27 RCW and <br /> 29G.200 WAC. // <br /> %=�✓( � � �Y-/.: I -. \ . T � �/. . ._ ,r� <br /> , � <br /> / z ;�PT°%' j/r i��' 7 <br /> Signato:c - Dat � , <br /> _Fd��9-�s� <br />