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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8870 - FAX 425-257-6857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> J�C� C� \ S-� ���� _ <br /> PROJECT ADDRESS <br /> ,��,a� v� ��on2k� ��3o�c 530 �.Os�k)� l,vA �1�62C�(, y2�, �54 316y <br /> Ownef MailAUdress City SlalelZip Phone <br /> Tenanl hlailAddress City Stale2ip y2� 2nOPj�p�Q� <br /> 'L '� <br /> -Cn.,�„ A��ve. �.\�d��� QOC�ox 61R3 ��r�wooe� U�A -�i�'�E, <br /> Elec�ncalConhaCtor ldailAddress City SIa1e/Zip Phone <br /> 'StyN�v�I.oSSKE ��`t.nno .c�o <br /> Slate Llcense Number Conlrac rice of Work <br /> `���\ P�Q.r <br /> Proposed Use of Building Contacl Person (Plan Review) <br /> Description of Woik lo Be Done: �V�S�A��n�\uv� �Z� �CPV�C�n C\'C Un,\� S � ���QA'� �`vTL <br /> 1.v����,\\ `c�r Av�eV. c�c �v..`.� 'Co `C�Q.� �ca�e Co�ni�co\\�e1� <br /> �u�iYo\ w�c.v�c� �v. C�'�h�1LA <br /> . <br /> NOTE: WIRING IN NON-DW[LLINGS IS RE�UIRED TO FEE <br /> I DE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br /> 1 hereby cerhly fhaf I I.�ve read and ei�nuned Ihis aPPhcv6on and krrow Ihe sarne fo bo frue and <br /> cortecf .411 provisions o!/a�rs and crdin,mces c�overrrinp fbis type ol�vo�k�vdl be complefed <br /> �vhefher sper.�Ged Ire�ern or not The granOng o/a pernnt does not nesume lo givo aulhonty fo <br /> violale o�cancel fhe prowsions o/any olher stafe or local law regul.�hng cronstnicfiorr or the <br /> �onom�:+�,ce or conslruchon That I am aufhonzed by fRo orvner ollhis property to perform fhe <br /> �vmk lor whir.h appliCahon�s rnade anA I contply u�ifh fhe Sfafe Cortfncfors Law 7817 RCW and <br /> 296.200 WAC. <br /> ` <br /> � ' � � �� <br /> , siqnaWre oalc '7,:� l <br /> � � V — - <br /> � ��, � <br /> a' <br />