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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 425-257-8857 - www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> ��.r.-_ C;�- <br /> �„ z�;,�� � C;� I `� .;���_ _,� <br /> PROJECT ADDRESS <br /> ���=n �1�,�� ,i>_�;:-_ <br /> Owner 1.1ai1 Address City Stale2ip Phone <br /> Tenanl Mail Addmss City State/Zip Phone <br /> ls� -, 1 k�_ �_oFc����i � ��oU :�c�<,C.,�� 57 <br /> � (, �i�.L1��� I`,-� � I�X 2G 1�1�J �hS\� � 1�.�1, y� �1 <br /> Electricai Contraclo Mail Address City StalNZip Phone <br /> _ , �y , <br /> �7 > > <br /> I�kr�(.�U fJ t `�Sl �' vJ � �� C C' <br /> Stale Liconse Number Contracl Prico of Work <br /> `�,�i.�t�,�� �- Adf� ��.�I r).�J1- �(_ 1 �._1 �� <br /> Proposed Use of Building � �— Conlacl Person (Plan Review) <br /> Descriplion of Work to 6e Done: �<`� 1�A 1�'<<' �U I�L�. f -?�ti` ������ �� Y <br /> �_ �_ <br /> / <br /> i�� ��L� :- jV � �f i - l- <br /> NOT[: WIRING IN NON-DWELLINGS 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 ceriily fha(I have read and eramined this applicalion anAknow fNe same fo be Vue and <br /> corr�ci. nn Nro��;srons or i��v::and ordinances governmg fhis type of�rork will be conrpleted �L, ��� 7 - C� � <br /> �rhefher spcuficd herein or noL The�ranfing o/a perrrirt does not resume fo give autl;only lo <br /> violate or cance/tlie rn�ovisions o/any ofher state or focal law reguPfing constructien or fhe <br /> pe�fomianca oI construc(ion. That I am authorized by fhe o�vner ol Ih�s property to pedomi the <br /> �vork lor which applicafion is made and I compty�rith(he State Confracfors Law 18.27 RCIN and <br /> 29G.200 WAC. <br /> � ' C ._. Z � % � - i � / <br /> � - -— t <br /> �tiignuture Date <br />