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( <br /> ELECTRICAL PERMIT APPLICAT!ON <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 /2 —/6 —/U <br /> 425-257-8810 - FAX 425-257-8857—www.everettwa.org —[!O �Z ���6 <br /> APPI'=ATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> ���,-/� �,.� ,q�.� <br /> L L Y� C" <br /> PROJECT ADDRESS <br /> 5�25-a��'�s�9 <br /> �,P �;vP�eli L���,"L �7 ial_ _/����/���. �v�r7� c✓h` `=d'�'a/ <br /> Owner Mai�Address City Stato2lp Phone <br /> �CV�.� !iS �(-SJ/I�� <br /> Tenanl Mail Address , Ciry �� S�ate/Zip Phone <br /> <''y�, - /� �'' /�vL'—� <br /> , <br /> �x.u,�� /'lc�cl��,�c:..l�v�,l�,.ts Gv�_•rt,� (�-r� 5'��a,��" �/��- �v -���� <br /> Eloclrical Conlrec�or hluc,:ddress City Stale2ip Phone <br /> ,5��<N l�i'-�S 1 S�/</2 .��� <br /> Stale Lic�nso Number Contract Prico of Work <br /> �L�i`'c`; t 4 ( C i/.'li C.. K'Z��7 � ..�;`��:r��r� . <br /> Proposed Use of Building Contaci P�rson (Plan Review) <br /> Description of Work to 6o Done: <br /> ��� �� // ��» L.•�:v v�� if 7-5�.� <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEVVAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby r.ertily Ihaf 1 have read and exarnined chis ap��lication and kno�v fhe samo to be fn�e and <br /> camcL All p�avisions olla�vs and adinances goremmg this typo oI�rork�vi�l be cornpleled <br /> tt�hefher speciGed he�ein or nol. The�ranfing o/a pernuf does nof presumo to give aufhon�y fo <br /> violate or cancel Oie provisions o/any other smte or local Inw regulating consfruction or the <br /> pe��omiance oI constnicfion. That 1 am aufhorized b}�fhe owner ol this properiy fo pedomi the <br /> �vork for�vhich applicafioit is matlo-ar�d I comply wifh fhe Sfate Conh�actors Law 18.27 RCW end <br /> 29G.200 WAG . C / 1 _/� C, <br /> �. .-�ti /��/i4%'�> o <br /> � � � <br /> Signalure Date ' <br />