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ELECTRICAL !'ERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES , <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 -wuvw.everettwa.org <br /> APPIICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> (�oy- C-)A��c--� �l✓� ��c�t,7- <br /> PROJECT ADDRESS <br /> �if�/.17-� �!'I�"fk'Gn-_ l�U� l,Jd2i7�� A�� �i E71 �(I WA 9 o L'D/ <br /> Owner IJ�ail Address Cily SlatelZip Phone <br /> Tenan� Mail Address City SWte/Zip Phone <br /> L��• <br /> / <br /> �-,,;r�,�.�rE-��;�_ r�zo 9c��N �.S'w r�v�� ,a 9EZ��f �0 9 aq�l�. <br /> Eledrical Conlractor Maii qddress City StateRip Phone <br /> �,rc�w��1, j3.3.�1 z9lX� `�' <br /> Slate License Number Conlract Price o(Work <br /> Proposed Use ot�uilding Contacl Person (Plan Review) <br /> , <br /> Jc'r,[[r.�]5 7a >>6�r G�/i.nc,i' �7Ar.lISfJ f� �t�.�E- Z ��/,'i[�r(S »�#k�fN <br /> Descriplion of Work l0 9e Done: — <br /> i;eFE�rr�,� ��;F���: �J %a�rJ C��re�r� lN,, rC,:,��n <br /> NOTE: �VIRING IN NON-DW[LLINGS IS REQUIRED TO FEE <br /> DE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certil fhal I have read and examined fhis application and know the same lo be frue and <br /> correcf. All p��visions o/la�ts and ordinances govarning Ibis type oI work will be completed <br /> �vhefher specilicd herein or noL The granfing ol a pen»d does not presume!o give authonty to <br /> violafe or cancel fhe provisions olany o,her state or local la�v regulafing consfruction or fhe <br /> pertornwn e ol consfruction. Thaf 1 am authonzed by fhe owner ol Ihis P�operty to peAorm the <br /> �aork lu� �YI icA applicafion is r(iade and 1 comply wifh the Sfale Confractors La�v 78.27 RCW and <br /> 29G200 W C. ,i ��, <br /> � �' � > ����.;�� ��� ��� <br /> •Signature_ �- Date <br /> �D71( �!S <br />