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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 TC 4 PM <br /> �s .x� i y��,- ,���1 <br /> � <br /> PROJ ECT AD�RESS <br /> OWner M11ail Address Cily Slale2ip Phone <br /> ��',� ���,��r� � I t'v���;�=T-� t,�A. 9 S� <br /> Tenant Maii Address City Slale/Zip phonc <br /> =•�6 z s7- ��o� <br /> � '>r � 1�n��vy �-i�cr/�,c ?�.i>,� �ov Gv.vNwa.�n U/f) 9svv6 <br /> Eleclrical Conlraclor Mail Address Clty Slate/Zip Phone <br /> .� <br /> I �rF n��a ,� r_ g-�z �� `�3 ��� <br /> Slate License Number Conlract Prico ol Work <br /> i2r s iD,-,,. ,- , n ( 1�'�,cF A,tiDF�rSu � <br /> Proposed Use ot Buildiny Conlacl Person (Plan Review) <br /> Descriplion ol Worh lo�c bona: ,[� tJ ,Q �i`7i✓�i F C�J V T(�^ T <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> � <br /> B6 IN RACEWAYS, MC OR AC CA�LE. <br /> CITY Of[VERETT LOCAI SALES TAX CODE IS 3105 <br /> � D�U" � <br /> 1 hereby r.wtil}�Iha(!hava read mid exernined this applicnfion and know fhe sarno lo be frue and � > - i 5 ) <br /> correcf. All provisions o/lnivs and ordinances goveming fhrs ty��ar„or��,�m ve co�„�rei�d <br /> whether speciGed herein or not The�ranting ol a perrnd does nol resurne fo gire aufhonty fo � <br /> t�iolafe er cancel fhe provisions o/an��ofher s(ate orlecal la�v reguPting conSWchon or Oie <br /> performance o/cansfruction. 1"hat I am aufhonzed by the o�rnor o/fhis property to perforrn(he <br /> u�ork for�rhich applicnfion is nwde nnd 1 cornply ivilh fhe Sfafe Con6actors Larr 18.27 RCV1�and <br /> 296.200 11�AC. <br /> 1 ' ,, .- ij! � ..��1�.__ � — � � U `Z; <br /> ! Signalure Date <br />