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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 —�v�•,nv.everethva.ory <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ({��6_O�S <br /> \ <br /> � (� <br /> 1.��/ �_�a,� / c � � i 1 <br /> J� � ��� J <br /> PROJECT ADDRESS _ <br /> 3�J'-���J <br /> � / ,%� J/J //,�,[/ /� //� <br /> C�'� /-�.^.� �r"rf ��s:��rJ "i/i-c l�iic.-c� �/�U 9(��C�/ <br /> Ownet Mail Address City S�ale/Zip ?henc <br /> Tenanl hlail Address Cily Slale2ip Plionc <br /> / �J 9e'�G�a'�} C-4z�) <br /> /� � ��(Q�')C ,S��J-IV�I✓-�/-�J� �✓G��i�� li�/,I J�S-��J� r <br /> L=leclrical Conlraclor 67ai1 Hddress �9 CAy State�Zip Phone <br /> �,�=v�-�xr-��c�- <br /> � -�� � ��� 17 ��J�/�� .� <br /> Stale License Numbcr Coniract Price of WorV, <br /> � <br /> �s('. <br /> i'" I!i /r. ,r�!C ��x.- � _ <br /> Proposed Use of Budding CoNad Person (Plan Revie�ti) <br /> i % � � <br /> Description ol Work lu �c Uunc: %�'�-'��+� Gtiq c.�-ti�� .'�i>�,, i� r�7c' 7-c+-i ��� yr� <br /> C'X �3/ ' iiG 4'GSi C`����(P . <br /> NOTE: WIRING IN NON-DW[LLINGS IS R[QUIR[D TO FEE <br /> � E3[ IIJ RACEINAYS, h1C OR AC CADLE. <br /> CITY OF[VERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby ccriily fliaf 1 have read and examined fhis npplication and know fhe same fo be fruc and <br /> coned. All piovisions ollaws and o�Ainances governin9 this type o/ivak�rdl te wmpleteA <br /> wfrether speulied herein or not. The gran(in�ol a pennd does not rrsurne to gn�e authonty to <br /> violate or cancel thr,`�rovisiors oI anv other slate or local la�r re�uPting construction or fhe <br /> perlorrnance ol construclion That I am aufhorized 6}�the o�vner o/fhis property fo perform the <br /> woik lor which appbca6on is rnade and I comply n�ifh Ihe Sfafe ConVactors Law 7827 RCW and <br /> 29G.200 WAC. <br /> �% " �� �..� �//G/p�' <br /> Signature Ua , <br /> �� � <br /> . o�-s� <br /> �; <br />