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( <br /> GLECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, VJA98201 G�'..D6`�Z <br /> 425-257-8610 FAX 425-257-P857 —www•everettwa.org G��2 o9�p?�Z <br /> APPLICATION•'a ARE ACCEPTED FROM 8 AM TO 4 PM <br /> ��z� �.�� � � �� �� � <br /> PROJECT ADDRESS <br /> � �69 i� �/�� � �v -�t� (�oX (Z�o Z �v�.�Z'�" Z�z�� <br /> Owner MailAddress Cdy State2ip Phone <br /> ��D�l� <br /> Tenent Mail Address City SlatelZip Phone <br /> �P l� <br /> EleclricalContractor MailAddress Cdy atate2�p Phone <br /> ��ob� _ <br /> Slate License Number Conlract Price of Work <br /> rn�'I��� — Contact Person (Plan Review) <br /> Proposed Use of Building <br /> Square Footage(If residenlial new construction,remodel or addition) <br /> (� 2 �(v'e �/�Ul �`'� � <br /> Description of Work to Be Done: ��� ��"' '�x � �` <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. ��5� <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby certily that 1 have read and examined fhis application and know the seme to be true and � 1�^� ��� <br /> correct. A/l provisions o/la�vs and ordinances govemmg this fype o/work will be.completed � <br /> whefher speci�ed l�erein ornoL The granting ol a pertr�d does not resume to grve au!honty fo �J`� <br /> violate or cancel fhe pmvisions ol any other sfate orlocal law reguPafin,q conshuclion or the <br /> pedormance o/consPruction. That 1 am aufhonzed by the ownero(fhisp mperty to peAcrm fhe <br /> work lor which ap '•afion is mad and I�the Stafe Confracfors Law 18.27 RCW and <br /> 29G.200 WAC. <br /> � �(� ��z <br /> Signa ure Oate ^� <br />