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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 /> ' Y:�' ��^ �.�C'-� U�.O r� E <br /> PROJECT ADDRESS <br /> J(�C���7 / ���4� ��i i�i �� � I' IJC�Y J�� I �Vti t�C�� � C>G�OC�� ���� 7L�G��S C'�� <br /> Owner A7ai1 Address City Slale/Zip Phone <br /> TenaN Mail�ddress Cily Slate2ip Phone <br /> ElectriCal CoNractor �dail AJdress City Slale/Zip Phone <br /> Slato License Num6er Contracl Pnce of Work <br /> i � <br /> ✓-�� �/>��,� <br /> Proposed Usc of Building Contacl Person (Plan Review) <br /> i • , /� <br /> Doscriplion of Work l0 6e Done: � � � %�/F�����i < «//�ClI7f� ��� <br /> i J / / <br /> r.t.'�/,', r, lL(',:^(�/(; 1/ � /:r�' ,'�G�, ,'v) /�cc,'/ ' L�� <br /> % <br /> NnTE: WIRING IN NON-DWELLINGS IS RE�UIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLC. <br /> CITY OF EVERETT LOCAL SALES TAX COUE IS 3105 ��U3 _ 15� <br /> I hereb}�ceriily(hat 1 ha��e rend and ezamined(his applicafi�n and know fhe sarne(o be fn�e and <br /> conece Al/provisions ollaws and orx/inmices goveming Ih�s type of work will bo comp!otec� <br /> whefher speafiod he�ein or noL The granfinn o(a pernuf does nof presume to give authonty to <br /> violate or cancel the pro��isions o(an}�other st�te or locol ln�r regulafing construction or the <br /> pe�fom�ance oI const�uc(ion. That 1 am aufhonzed G}-the ownar o!this property ro pedomi the <br /> �vork for which application is made and 1 compl}�wlth the State Corifmctcrs Law 18.27 RCW anA <br /> 296200 lNA C. <br /> , i <br /> . . . -� . � , ��� <br /> .� , � <br /> 1 , �� . �i' �i�� <br /> � Si�natdre Dale /� <br />