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ELECTRI�AL PERM{T APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 95201 <br /> 425-257-8810 - FAX 425-257-8857 -www.everettwa.org �- I Z-�s <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> '•"" V�� � ��c� �lJ Y S+��t._�-�-� <br /> PROJECT ADDRESS � <br /> �/J Cirx,__ 5�'�SL UC`� �'e �.11-�� `L�j� — <br /> Owner M19ailAddmss City StatelZip Plone <br /> Tenant Idail Address City State2ip Phone <br /> � l er-fY�� 4��� �19 i � � ��r v e�..-, w� �-_s�z �,�-# �a <br /> Iectrical Contractor Mail Address City � Slate2ip Phone <br /> ��� �,��` ��<< I <br /> � L!S I �`1- d�� � V� Z �-�''�' —` <br /> �tale icense Number CoNract Price o(Work L�ZS <br /> ����1�-��1 �(� uo s c-�-� lati, .ls�. o � Sc��--2s-3o <br /> Proposed Use of Building Contact Person (PtaRR¢vfcnm) <br /> Description of Work to Be Done: ��.If i A 1 L�w �i(Vl �� C) �X'��LD�'L-\ 5��--� V''"e 0 <br /> �_ ���,`.,��vwe�� �-�z�.��, 4 �n�ti�ti� .�„� <br /> �(7,e���c_r� 0 0 �—{3_y��sZ <br /> NOTE: WIRING IN NON-DWELLINGS IS REDUIRED TO FEE <br /> �E IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF E4ERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby cerfily fhat 1 havc reaAand examined thi�applicafion and kno�v fhe sarne fo be true and <br /> cormc.t. All provisions o/laws and ordinances goveming this fype e(work wil!be cornpleted <br /> whether speal�ed herein or noL The granfing o/a pernnf does not resmne to give authority fo <br /> violale or cancel the provisions o�any other sfate or local law reguPling consGuction or fhe <br /> peAormance o/censtruction. That I am aufhorized by the owner o/Ihis propeAy fo perlorm fhe <br /> �vork lur whi.1���pplication is made.and 1 comply�vifh the Sfare Contrectors Law 18.27 RCW and <br /> 296.200 W C.1 <br /> �, � , Z � - <br /> Signature ale <br /> J����� � � <br />