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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www.everetlwa.org f ` a 7`�� q <br /> Ci 'ooi_.0� ( <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> .�`Cl/ � /�GfCl�v-��Z rFv'�� <br /> PROJECT ADDRESS <br /> �/ L�nJS �Of(i1a.J .SGn/ Sr( ��f� �/CrllfrLT l.(�� 5� Zd � <br /> Owner R1ail Address Clty Slate,�Zip Phone <br /> �'vNn/ �u� / �l�x ��C1�t.Z frUC el/cn��-r wa 4'S'la/ <br /> Tenanl Mail Address City SlatelZip Phone <br /> ��z� CI�C �SLZ I�iccC�-oK /J21�= �J-c2�-� 7-UA �Zd' k�� <br /> E-lec�rical CoNraclor Mail Address City Stale/Zip Phone <br /> �'/2.G�GG.!C/S� I��C/ l/U�I /-. <br /> Slale License Number Conlract Price o(Work <br /> ��(� � '� ��� -- <br /> Proposed Use of L'uitdinp Conlac� Frdson (Plan Review) <br /> i <br /> Oescription of Work lo L�e Don^� ��C/JG6qt,Gf> ��LT�2 �u Cr J « �.-� G—�L:C �'�A�o L � <br /> --1------------ <br /> NOi[: WIRING IN NON-DW[LLINGS IS REQUIRED TO FEE <br /> 6E IIJ RACEWAI'S, MC OR AC CABLE <br /> CITY OF EVERETT LOCAL SAL[S TAX CODE IS 3105 <br /> I heroby certity fhaf 1 have read and eaarnined;his applica�ion a�id hno�r fhe same(o be true and + � � <br /> coirecL All p�ovisions ollaivs and ordinances,qot�amrng this t}�pe ol werk n�ill Ge completed �1 �,1I � �� � <br /> whefher specJied he�ein or not. The yranting o!a pernut do�:s ne} uesumo lo gire authority to <br /> violatu or cancel the r�rovisions ol any ofher stafe or local lan�re�u�afing consfruction or the <br /> performance o/consfnicfion. That 1 am aufhorized by the owner o/this property fo pe�fonn the <br /> wak lor�vhich applicaGon is rnade and 1 compl}�wilh fhe Sfate Cenfraclors Law 18.27 RClvand <br /> 296.200 11'AC. <br /> _ "�.' _ � <br /> — �j;�v� �a. �4,rd <br /> � Signawie Uate <br /> 1 <br />