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� 'i <br /> ELECTRICAL PERMIT �PPLICATION <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 a PM -DEBIT 8 CREDR CARDS ARE NOT ACCEPTED <br /> ��r� '> (�l��N�G' �t �� <br /> PROJECT ADDRESS <br /> ._1 yt�tvtt S' S' : �0 Y �"�'— f'_vL'P�"C� l.U{�I, .��r2�(v �!-2��i�z <br /> �'�er Mail Address City State2ip PAone <br /> ��( .� ��-z�3 G�9�'�v,.�oa"�,,�2ETt c�lJ�_ 9�z6b �Z�4� <br /> Tenant Mail Address Ciry Stale/Zip Phone <br /> � �— µ25= 377 �// � <br /> �(_- I�NI�LS�� ��}IZ-ll�'I{�,, � ��cieS'feVeti.s. (� 4575'�'f 9z5-33Cs-2�z7 <br /> Electrical Contractor Mail Address Cily State2ip Phone <br /> Dc�� .'R�r= -�' �7�r�7 �/„ =Y `� :z ��; c9-e-� <br /> State License Number In /l� V� Contract Price of Work <br /> c� � ,,,+ , � f I hV <br /> r�'e-,�.��`G ca-..� '/, J <br /> Proposed Use of�uilding t Contact Person (Plan Review) <br /> �a � �� - /n/ <br /> I Description ot Work ro Be Done: �L.�x �tt�li/�_� ����c�C �Q. �L3'e_I��(�� f�LQ_y <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE � <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certily thaf 1 have read and examined this applicafion and know fhe same fo be fn�e and <br /> correct. All provisions o/laws and ordinances goveming fhis fype ol work wi116e completed <br /> whefher speafied herein or noL The granting ol a permd does nof presume ro give authonty to <br /> violate or cancel the provisions ol any other sfafe or local law regulating consfrucfion or the <br /> pedomiance ol construchon. That/am authonced by the owner o/tbis property fo peAorm the <br /> work/or which application is made and I comply with fhe State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> J <br /> m�-�' C� �., .�-3 _ 2��s� �' D <br /> Signalure Date /� <br /> �� � <br /> UJ <br />