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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CE�AR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 — w�v�v.everethva.org <br /> I <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �„f6�� <br /> �� _ — <br /> / II `( / /1 J�/�Y.S � �✓G( � <br /> PROJECT ADDRESS � <br /> ��fls—� <br /> �. � ,.. �--- / <br /> ,/i.� _, �/�"�� li. .�_� ��'t j__�.�rr: � f��f ��;1��'�v/ .�C,1 ,_�:1�3_: <br /> Owncr r.hw;vtf�r.,�, t:�l� Staio2r,� Pnone <br /> TCnllnl '�� ���� I.1.ui:ab;o..•, ��� � Ci�� � �� SIBIo;Zq� Rhni�p <br /> �7 / r �r, f1��,%.S'.J�'�7�,/ . <br /> !��/ ��cl7�/c �.Jr�.�-�L��J,� ���c J�� G 1��-yc-.�r �//�i�'�`�1��7G�rf� <br /> Gleclrical CoNraclor Mail Address Cn�� Stale2ip Phone <br /> ��/Jl-G�'/,Z 6�l g� �0 0 � <br /> Stale License Number Conlracl Price of Work <br /> /�C i�r�ir� C� ��/ <br /> Proposed Use nf�uddinr7 CoNact Person (Plan Revie�v) <br /> i / / � / <br /> Description ol Work lo Be Done: �Z f-W � .� C�C- o,. d '%I-�C-�N<:-�.,�,,�: 7� <br /> C'X�/�/����i !/YS /,CY`'��ir_ � <br /> NOTE: WIRING IN NON-CWELLINGS IS REaUIRED TO FEE <br /> BE IN RACEWAYS, h1C OR AC CA9LE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br /> 1 hereby certity fhaf/lro��e read and examined Ihis applic�tion and kno�r(he same fo Le Vuc.nd <br /> conecL All provisions ollaivs and orAinances�overning this type o/work�vill be complefeA <br /> whefher specilicd herein o�noL The yranfing o(a pennd does nul n�esume to gire authonfy lo <br /> violate orcancel fhe provisions o/anv other state or bcal law regul3fing consfruction or Ihe <br /> performance ol construc(ioa Thaf 1 am autliorized Ay the owner ol this property to perform the <br /> work lor which applicafion is ntade and I comply�riih the Slafe Contracrors Law 782i RCW and <br /> zss2oo�vnc. <br /> �-- � <br /> i -�'�j . __.- z �l ��s� �-, <br /> SignaWre � Date / _ <br /> '���'� V <br />