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� � <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES 3 �is-�z <br /> 3200 CEDAR STREET, EVERETf, WA 98201 C �Zo3—� � <br /> 425-257-8810 - FAX 425-257-8657—www.everettwa.org <br /> APFLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> �3 � 3 c.��o.e�— ���k 2� �� <br /> PROJECT ADDRESS <br /> �'1 a-S{-o� P�.Y� Til120 /VI�c.L�`� r2�1 sf T /�Ins ��{' Bo>"liaC� 1tXc �l�U2/ <br /> Owner MailAddress Cily Slale2ip Phone <br /> Tenanl Mail Address City Slate/Zlo Phona <br /> Yys <br /> �'�-u,U+-o �1e� �. PaB� z�fs S�1�nu.c� 9�L�i � �� �zsy <br /> EleciricalContreclor MailAddress Ciry Stalc2ip Phone <br /> 'V�-�l�l.Y� � �� 7� � � <br /> State License Number Contracl Price of Work <br /> i � � <br /> �L��✓I /J cJ �-2 (N FV S`� ' <br /> Propose Use o Building � Conlact Person (Plan Review) <br /> Descriplion of Work to Be Done: I U1�.� �;�)�l C� f� 1���� <br /> � , <br /> NOTE: WIRING IN NON-UWELLINGS IS RE�UIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 r (� <br /> I hereby ceAi(y fh2t 1 have read and examined this npplication and knmv fhe same to bo Irue and C�� Z-�3` � `! I <br /> con�ect. All provisions o/laws and ordinances govemmg this fypo ol work wi/f be completed <br /> whcther speafied herein or noL The granling o(a penmf does notp rosumo fo give aulhonry fo <br /> violate or cancel fho provisions olany othersfafe orlocallaw regulating consfruction ortho <br /> perfomiance o(construcfion. That 1 am aulho�ized by the owner of this property fn pedomi fhe <br /> work lor which application is mado and 1 compty�vith the Sfate Confracfors Law 18.27.4CW anJ <br /> ..96.200 bVAC. <br /> ����� 3��/zd�z <br /> Signature Date <br />