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Z <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETf, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> � �7�� I\I l(�v:(—�.�C � <br /> PROJECT ADDRESS <br /> �� �' � <br /> � � <br /> �-� �In�f:� I '� ,Y� �i �<J��l � �-�' . I'i/��2�f i ti`rt �`a <br /> , <br /> Owner Mail Address City Slale/Zip Phone <br /> Tenanl A1ail Address City Stale/Zip Phone <br /> ��� � (c r�(r�c I'•D. �o��l�r ����1�;a1� ���a �f�6o� ��:��7�r�=l�-�lr <br /> Eledrical Conlraclor Mail AJdress City Stale2ip � Phone <br /> D/�1�!_I�K(���(>Kl( ��- <br /> State License Mumber � Conlracl Price of Work <br /> ,lI ^ � <br /> 7�E�`7 l(�E'1tiL�' ��r:,r�-�c?"-�?�l�-fl� <br /> Proposed Use u�Ouilding Contact Person (Plan Review) <br /> i 1,�, 0 / <br /> , <br /> Descriplion o(Work lo f3e Uonu: � )l,(� . �� �, �ly��+[%�.�.CC1.t_.�� l�e/^ s�� �f/� ('� Cl i.l C2C���C`i C���u�� <br /> << ``�� L�n Il I�`f, ,.rY . <br /> NOT[: WIRING IN NON-DW[LLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVER6TT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certil}�thaf I have re�Annd ea�amined this applica(ion and kno�v fh�same to be hue and <br /> corrocl. All prorisiw�s ol laws and ordinances govemmy this f}q�e oI�rak irill be completed <br /> �rhefher spec�6eAherein or noL The c�r.nfin�o!a pernuf does not �resume fo gi��e aufhonty(o <br /> violafe oi cancel the navisions ol an}�other stafe or/ocal la�s reguloling consfn�chon or fhe <br /> pe�fermance o/cons�ruction. Thaf 1 am authorized by(he on�ner ol fh�s property fo pedom�!he <br /> work lor which application is made and I comply wifh(he Sfate Confrac(ors Low 1 A.27 RCW and <br /> 29G.20qM�AC. .. ' � / -- / �� J �-� ( <br /> � �} _ �!J <br />- � i ry/� � <br /> � � �_- /��'� ��'�� / ' �� � <br /> Si�nalure ��7 Ua�� <br />