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< <br /> �, <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 �EDAR 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 /> �' ( S f��cw �� �,� �' <br /> PROJECT ADDRESS <br /> Ownef hlail Address Cily Slate/Zip Phonc <br /> Tenanl Idail Address Ciry State/Zip Phone <br /> l� 1-���e ELccl-�,�ul (oyZ� 9 '� �c S�� �,l�e.������ ��9 9�?-�� (� u2�5�6� <br /> L"leclrical ConlraClor Mail Address Cily Stale/Zip Phone <br /> (ti�Nr����f�szaG S�o� °`' <br /> Stale License Number Conlr2cl Price oi Work <br /> � Conlact Person (Plan Rreie�v) <br /> Proposed Use ot Building <br /> Description of Work l0 6e Done: �l M`/" �I �� / " 'V r �� '" �� �`" ' I <br /> NOTE WIRING IN NON-DWELLINGS IS R[QUIRFD TO FEE <br /> BE IN RACEWAYS, MC OR AC CADLE. <br /> CITY OF EVERETT LOCAL SALES TAX COD[ IS 3105 <br /> I hereby certily tHa(1 have reaAand exmnined Ihis application and know fhe same(o Ge 6ue and <br /> �orrecl. All provisions ollaws and ordinances yovermng fhrs type oI�vo�k will be complefed <br /> �rhelher spcalied hercin or noL The c�rantmg ol a pennd does not presume to give authonfy to <br /> �n�lofe or cancel lhe provis�ons ol any other state or local law repulating consWction or the <br /> performar�ce o/const�uctiort That I am authonzed by fhe owne�o/this property fo perfomt fhe <br /> �ti�ork lor u�hich application is rnade and I cor;ipty�rith the Sfate Contracturs Lan� 182i RCIh'and <br /> 296.200 WAC. . ---- -.. <br /> / .. <br /> ��=' � �� �����6 <br /> , <br /> Signature Date �( ,r_ (� .�� ' <br /> V\L) <br />