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ELECTRICAL PERMIT APPLI(:ATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 � �./}?/Z� � <br /> 425-257-8810 - FAX 425-257-8957—www.everettwa.org <br /> �joo6- � <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> ` 1 , �) � , <br /> l�V / `'�I.1 / ��{ ^( ������ � .i C (<i �� L'�/�iy. � �� . � � <br /> PROJECT ADDRESS <br /> �l � !� J � � � �`J� ��,� (h�-Y �.,� ;,� tt wa �»-pj `l�5-�i`JG <br /> Owner Mail Addmss Ctly Stale/Zip Phone � � <br /> Tenanl Ma��Addross Cily Stale/Zip Phone <br /> ��hu�� f�r�.�,;�� 1�U �i��� f ��,1' e,-�'l l�a� ��i'�.✓ � �17.5_ �'�` <br /> Ele trical Conlraclor j H���� Mail Address ' City State/Zip Phone L�I I�' <br /> �<L <br /> A,��;� �� ����� °l ����� t.� � �J J <br /> Slate Lidenso Number . Contract Price of Work <br /> �� � /� �,� <br /> / i �- �� �t ,�.� S i� . <br /> � � � � <br /> Proposed Use of Building Contact erson (Plan eview) <br /> �/')-'i 7`3 3 ( °! �� � <br /> i � <br /> Doscriplion o(Work�o Do Dono: ����� � ,.� Oj �f� \�-'!_ I '��� � � L ��\ 11 � � <br /> NOTE: WIFING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> r <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> :YereGy certi!}�fhaf I ha��e read nnd examined fhis applicafion and kno�v the serne to be true and r'����� _� �1 GJ <br /> correcL All provisions oll��rs nnd ordrnances�o��eming fbis t}�pe o/�rork will be coniolefed � <br /> n�hefher specihed herein or naf. The grantinc�o/n pernuf does nof resumo to give aufhonty to <br /> violate ar cancpl lhe provisions o/any ofher sfafe or loca!lar eguPting cons6ucfion or llre <br /> pe�fonnance dr eonstn�cfion. That I am autho�ized by the oe..aer o/fhis propeRy to pedonn fhe <br /> �voih lor which applicafron is made and I comply ivith the Sfate Cenfrnctors Lnw 18.27 RCW and <br /> 296200 INAC. <br /> � ---�_ J�n �l� 1��� <br /> Signaturo Date <br />