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( <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETf, WA 96201 <br /> 425-257-8810 - FAX 425-257-6857—www.everettwa.org 3 —3�a/� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ���� y�� <br /> So.S �vq vPv-�y <br /> — � <br /> PROJECT ADDRESS <br /> �� / s�� s �.,��� ., �_ 1=� <-, �� t) w,� ���oi <br /> ��c� i/•v L,pi'P��fZSoi� / � <br /> Ownerf MailAddress Clty Stale/Zip Phone <br /> NI� <br /> Tenanl Mail Address Cily Slate/Zip Phone <br /> QLC �: lcc �r��c ��-�c , �,G� ��,1 �.�%9 /y.Lh knwa�-.c0 U-i�- `�l £3 � 5�`Z <br /> Eledrical Coniraclor Mail Address Ci1y Slale/Zip Phone <br /> IJL,CeL 7_ ,'X-Ol/G'G �I�Z�// � 8ncr , 0 O <br /> Stale License Wumber Contracl Price of Work <br /> Jlilc�/•' � �3-I>� il�� �C�ryr ��/h(c�0/.� �- ., . <br /> Propo d Uso ol8uilding Contacl Person (Plan Review) <br /> Description o(Work lo[3e Done: Y1 r y l i�-� t^ �- X�,��"7-� /7C,` �.O�,4 �" �e°c�"r, r�,a � l"n-vi P � <br /> �^/� N P G�.� <br /> NOT[: WIRING IN NON-DW[LLINGS IS REQUIRED TO FEE <br /> �E IN RACEWAYS, h1C OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby ceriil��Ih?t 1 have�ead and ex�rnined Ihis applicofipn and knew tbe same to he frue and <br /> cenect. All piorisions ollaws nnd eniinances�overnuig Ihis fype o/work will be cornplefed F\�(;�-�'C l-� <br /> n�hefHe�speci8ed hcrein o��noC The g�anling o/a perntd does not/uesume to give authnnty to <br /> violafe or cancel C�e �rovisions olan}�other state oNecal Imr mgu ating cons6uchon or fhe <br /> pe�formance ol s i �ction. That!am aufhaized by the o�t�ner e/0us property fo per(onn!he <br /> work lor which .pplic�fio� ' rna and 1 comply with the Slafe Ccn6actors Law 18.27 RCW anA <br /> 296.200 WAC <br /> ���-� ���/�� <br /> Siqnalure Dale <br />