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� <br /> ELECTRICAL PERMIT APPLICATION <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 <br /> ��Z`1 ��✓e-Fll�tll� /� (�� �l�e�!c�j� U'�'� ��} I <br /> PROJECT ADDRESS <br /> �CC"�� {'1'����5��-r /4zw Gt�ea�rncr�AVE �t�Pre-t{ LtrA yzS �.�a- ��5'6f <br /> OWner MailAddress Cily Slale/Zip Phone <br /> Tenant Mail Address Cily Stale/Zip Phone <br /> Electrical Conlraclor Ma�l Address City SlatelZip Fhone <br /> State License Number Contracl Price of Work <br /> {-ls't —1�.5 a(����z �,� . <br /> Proposed Use ol Duilding Conlact Person (Plan Review) <br /> Description o(Work lo Be Done: ���U a l� (�,v ��"�`��` '\���� <br /> �. <br /> NOT[: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN F2AGEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certily thaf 1 have�ead and examined Ilris applicalion and know the same to be In�e and <br /> correcL All pro��isions olla�vs anAordinances go��emmg fhis fype a!work will Ge complefed <br /> �vhefher specilieA hercin or noL The granting o/a penmt does not presumc to give aufhority lo <br /> violale or cancel fhe r�ro��isions oI uny ofher slate o�loca/la�v regu�afing conslrucfion or the <br /> pe�famance oI consfruchun. That 1 am authorized by the o�vner o!flus propeRy lo peAorm fhe <br /> n�ork lor�vliich applic.�lrun is made and 1 comply wifh Ihe Sfate Contractors Law 78.27 RCVV and <br /> 296200WAC. -�� � <br /> ,;��'���� `7- C- ss <br /> i <br /> /SignaWre Date <br /> �G�-��� <br />