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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 y _aq-og <br /> 425-257-8810 - FAX 425-257-8857 -www.everettwa.org �QS6 �`I �/ <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> ) � /// � <br /> l � 7�t� /� i C�/�"�tii <br /> PROJECT ADDRESS <br /> �,, <br /> ;�� � <br /> � y, ,'-,-�y, �, ��c,;.� i c, � �' ,� �(�,� Grl y z5- 7S'�.5�� <br /> Owner I P,fail Address C�ty State/Zip Phonc <br /> Tenanl 1.1ai1 AAtlress City SlalelZip Phone <br /> /��: �-- <br /> Eledrical Conlractor F.fail Address CPy Stale2ip Phone <br /> Stale License Number CoNracl Price of Work <br /> Proposod Use n(f3uilding Conlacl Person (Plan Review) <br /> � i <br /> Deseriplion of Work lo Dr. Donc: � � ����,.�J � i� .�.;J �6 �� �� <br /> — o / � <br /> / �� �,+' �J-- 1ti �-�i/i!, GC�C 7✓ -c' /li�p' t,{J <br /> NOTE: W.IRING IN NON-DVVELLINGS IS R[QUIR[D TO FEE <br /> � 6E IN RACEWAYS, �1C OR AC CAf3LE. <br /> f <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 f � <br /> ��'-� {�-l.� ' �"� � <br /> I hereby ccrtd}�th.�t 1 have rnad and examincd this applicafion anA kno�v fhe same fo bc frue and <br /> correcf. All piovisions olla�vs and ordinnnr.es�oveminc�lhis type oI work�rlll be comple(ed <br /> whethcr speci/ied hercin or not. The qranfing o/a pennd does nof �resume fo give aufhonty fo <br /> violate or cancel fhc provisions olany other state or local law regul7fing consliucfion or fhe <br /> pe�formance u/consfructior7. That I am authorized by the ou�ner o/this property lo perforrn Ihe <br /> work lor�rNich applicalion is made and I compty�rifh fhe Sfafe Contractors Law 78.27 RCW and <br /> 296.200 WAC. <br /> �, � � � <br /> � I <br /> � ,f_,�--�.���.�-'�'� ` �.'�� `�` � `I- U �� <br /> ' Si�7naturc Dale <br />