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ELECTRICAL PERMIT APPLIGATION <br /> CITY OF EVERETT PERMIT SER��ICES <br /> 3200 CEDAR 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 /> I � �.� � j� :.� i"Cl r_ i'' /JlL: �' <br /> PROJECT ADDRESS <br /> � � / <br /> ���zs)zs8-°lS s <br /> ���i%, - , i,,� , . • �. :f 1 � r•����?S Q,�c�1 er /�V�� �'��r r��(�" Lv F� �1�Z D � <br /> Owner �' Adail Address City Stale/Zip Phone <br /> � " �� _ <br /> TCn3nl hlail Address Cily Slate/Zip Phone <br /> ; e � f�rc.t��'c ,:t�,� l�o Pw k 2 y5 8 E vt're C� ��1.�9�2 L� �%ZL� Z y <-o <br /> Elec ical Conlrado� M17ail Address City Slate/Zip Phone <br /> 1�� �r �� �` J— y 77 C L I�dO `�o <br /> Slale License Number Conlrac�Price ol Work <br /> !' / <br /> SIn t � ��••�� K — <br /> Proposed e o(�uilding Conlacl Person (Plan Review) <br /> l <br /> Description of Work lo E3e D�ne• J� 'f —�, J;�^C �y�!f r>��, .� Sa�t���� C�d � A h e �c <br /> J <br /> � � �L.L( � �' S . <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACE\NAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereb}�certdy!haf 1 have read and examined this applicalion and kno�v the same to be Irue and <br /> correct. All provisions ollau•s and ordinances go�emin�fhis type oI work will be complefed <br /> whefher specilied h:rein or noL The granfing o/a pemut�ues not uesume to give authunty fo <br /> viola(e or cancel Ihe urovisions o/any other_lafe or localla�v regul3fin�conslruchon or rhe <br /> peAormarce olconstruc(ion. That 1 am aufhorized bythe avnerolfhis p�opeAy fo perforrn the <br /> �ao�k Ior ufiich applicafion is made and I cornply�vilh the Sfate Contracfors La�v 1827 RCW and <br /> 296.200 WAC. <br /> ��� 1 / <br /> >_��� P�cs ��c�rc� � G �ll/ S�O � <br /> " S�g�ature Date ��T <br /> EGso;-oSz <br />