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� <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 � ���_�b <br /> 425-257-8810 - FAX 425-257-8857 -www.everettwa.org <br /> E l0o/-D�O <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> ���;�5 ��c���� /11,�' <br /> PROJECT ADDRESS <br /> J�-��r�^r�) S�ev�Rs �G�l`� I�r��,lCl=i� ��ue r.' l�/'Ri'�I u�19 f� <br /> Owner 1,1ai1 Addmss Cily Slale2ip Phone <br /> 5)'1i/n37N �t'�s`�y 1�-05'1� <br /> -IIS" dYd.� <br /> Ten3nl Afail Address Ci�y Slate2iU Phone <br /> '�i�/// �.�1� <br /> Eledric:tl CoN�aClof f.1�il AJdwss Cily SlatelZip Phrn�e <br /> Slate License Number Conlracl Price of\Nork <br /> Proposed Use o�Ouildinc� Conlacl Person (Plan Review) <br /> DoscriplionofWorkto�eDone: ��(f�n1'�(� � �-��SIIN�� L�EC�- SF�Z��L� '^� �� �7�'�u� <br /> NOT[: WIRING IN NOIJ-DWELLINGS IS REQUIRED TO FEE <br /> [3E IN RACEWAYS. A1C OR AC CA(3LE. •-�� ���J <br /> /c �_ <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> !liereby certil}�thaf I l�are roc�d and ea�nntined tfiis applicn(ion and kno�r llie sanie fo be true and <br /> cortect. All proaisions e�lau-s and ordinances gor��imng this type o/i+�ork�t•ill be complefed <br /> tvhefher speciGed herein or not. The grantin�o!a pernut does not 1'CS(If110 f0(fll'C fiU�IlOdf}�to �- � <br /> �dolafe er canccllhe �rovisions o/any ofher state erlocal lanv repuPling cunsiruchon Or fho <br /> pertormance ol cons�iuction. That 1 am autherized by fhr ouner o/this propert}�lo perfonn tho ! ,�' <br /> �vork lor�vhich applicafion is nuvde and I cornply�rifh fhe Sfafe Cenfnvcfors Law 18.27 RCLV anA , ( t <br /> 296.200 11�A C., � .;% ',� <br /> �� � �'_�.�.�1�"'i/�� ��_�.,c_-��. <br /> :---Si�nalure _._—� Date <br /> / � <br /> r. <br />