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ELECTRICAL PERMlT APPLI(:ATION <br /> CITY OF EVERET'r PERMIT SERVICES <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 /> � <br /> �; X 1 � ����-�< < ��-,-' /f✓c� <br /> PROJECT ADDR�`SS <br /> � / , <br /> �� 0 /C� —� /Ni-`` /`,� 1''ClS � �/, ��'�� l �l,;�c.l <br /> Owner `� Mail Address City Stale2ip Phone <br /> Tenanl Mail Address Cily SlatelZip Phone <br /> � � � — .� <br /> �� ' <br /> Electrical Contraclor A4ai1 Address City StateiZip Phone <br /> ��7 l C� <br /> Slate License Number Contract Price o�Work <br /> Proposed Use of Building Conlac�Person (Plan Review) <br /> / ' ` � f / �,_,l/ <br /> Description of Work lo Be Done: �i. -c� I"�l�'fL e� 7 � /'7 �' � /X. / v�'�"Z� 5 ����� � <br /> ° V <br /> ��/�r Ylxf���c� S <br /> NOTE: WIRING IN �ION-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC C.ABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certily that 1 have read and examined fhis applicatioit and kno�r fhe same to be Irue and <br /> correct. All provisions o(la�vs anA ordinances�o��ernirg fhis type ol�vork�vill be completed <br /> whefher spealicd herein or not. The c�ranling o/a pernut does�iof �resume lo give aufhonty lo <br /> ��iolate or canccl the provisions ol an}�olhei sfate orlocal law rcgul,�ting cons6uction or the <br /> perfonnance oI consfruc(ion. That I am aufhorized by fhe owner o/fhis propeMy to pe�fonn Ihe <br /> �vork lor�vhich applicalion is made and 1 comply with the Stafe Con6�xfors Latv 78.27 RCLI�and <br /> 296.200 INAC. <br /> � ',! ,.'.L- ; i., r,..� ;; - � V •- L' (�, <br /> r � �SignaWre Date <br /> i �� �� � � � � <br /> � <br /> i ��� <br />