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ELECTRICAL PERM�T API'LICATION <br /> CITY OF EVERETT 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 S _� S �,p� <br /> � � � 5 ��L? '�)U rt c� N��� <br /> PROJECT ADDRESS <br /> 1���' S �� a .n12�� ��� �' Ser �u � s�" �� �1��0�. ���1- �199 <br /> Gwner ldail Address City Stale/Zip Phone <br /> Tenanl 1.1ai1 Addmsa Cily StatelZip �honc <br /> �f���, �� �3 � 6 ( lZe,�.-(.� Av� �.��nn�l� �'1.��,0( yzs-`�,.55'= � �( <br /> 6leclri al Conlraclor Mail Address Ciry State�Zip Phone <br /> r, v�.�t x �� r�t 2�. � (�� r t �I-��,�. <br /> State Lir,ense IJumber Contract Price ot Nbrk <br /> Proposed Use of�uilding Conlacl Person (Plan Review) <br /> Descripti�n of Work lo�e Donr.: N P�� + ��Lt A.Zt �0 U N 1"���1� � �� V1 Q r <br /> NOT[: WIRING IN NON-DW[LLINGS IS REQUIRED TO FEE <br /> dE IN RACEWAYS, MC OR AC CABLE ��—c*� <br /> � <br /> � CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> 1 h�reby ceriil}�fhaf I have read and ea�antined fhis application and know the same to be frue and <br /> cenecL All provisions ollaws and ordinances,qo��emmg this fype o/work will be com.pleted <br /> a�h�lher spealied hemin or noL The granfing ol a pennd does not presume fo give authorify to <br /> violafe oi cancel fhe �rovisions ol any ofher sfale or local law re�ulafing consfruc6on or(he <br /> pe�lormance ol cons�rudion. Thaf I am aufhurized by fhe o�rner ol fhis propeMy to perlorm the <br /> wo�klcr ivhich�pplication is rnade and I compl}-wifh fl�e Sfafe Contraclors Law 18.27 RCl1'and <br /> 29G.200 LNAC. <br /> � � � � ' <br /> ,/.��-,-�. :� S� � 27� 0 r/ <br /> / —Signat� / ate <br /> i <br /> ." L ) L5 � 5 �5 <br /> 1 <br />