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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STRFET, EVERETT, WA 98201 <br /> 425-257-881^ - FAX 425-257-8857 —www.everettwa.org <br /> APPUCATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � � c� �� <br /> �/� / S� ✓,'e ocJ w�z �N1n� k�.�,ku E�.�✓LtI� <br /> PROJECT p.DDRESS <br /> Owne� �dail Address Cily StalelZi, Phone <br /> Tenanl A1a I Address Cily Slate/Zip Phone <br /> �!a?s-soc-,y�� <br /> �3C /^/ CC TjZiC yNav NE3uH$g} [�/uc�Su �/r C y 2�e���,� Wl4- �J8af9 <br /> Eleclrical CoMractor Mail Address City Stale2ip Phone <br /> c-�� —�a-:�A ��<° � �!��= ��;;�:-�l� �"�A, � <br /> S�ale License Nuntber Conlracl Price of Work <br /> �KSiG.1�8h. �i2! �7i/.SEr� L' lt4✓ e Z <br /> Proposed Use of Building Contacl Prrson (Plan Review) <br /> Description of Work to De Done: ���e_ �c�roo.... '�o q �'},�G.�,/f fQr«„(cer-- <br /> /� $aJt n.ti,�i' J - / <br /> � kr Tu ���G � im/ TQCGC/2% f IZ�G �UC_' 4,�'G �t2L�� tL� .S� L��1_QS�� <br /> f�+S �./I/Po�4 Yaor.1 . <br /> NOT[: WIRING IN NON-DW[LLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, h1C OR AC CABLE. <br /> CITY OF EV[RETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ccrtil}�that 1 have itar anJ examined Ihis appGc�tlun cnd know flre same fo be frue and <br /> correct. All provisions ol la�ti�s anA ordinances governine�tl�is lype ol work wil!be comple(ed <br /> whclher specJied herein or noL The granfing o/a pennrf Aees nef presume fo give authonty to <br /> riolafe or cancel Ihe pro��isions ol any ofher statc or local law regu/afin�consfruc(ion or the <br /> peilorn�ance o!cnnstruclion. That I am authorized 6y Ihe oivner of fhis property fo perfomi fhe <br /> work lor which applicalion is made and I comply�rith the Sfafe Contracto�s Law 1 A.27 RCW and <br /> 29G.200 WAC. <br /> � <br /> �_/—�•�-�-� �-�9'�O!� <br /> Signalurr � ( Dale <br /> --.._.--__—__— / ��/ <br /> �°v <br /> � <br /> � <br />