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r <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PcRMIT 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 /> 2404� �v'.e1 n-•n�^ �� <br /> � ; ., z r ��-, `i %���3 <br /> «--�—���--___�-�� <br /> PROJECT ADDRESS <br /> �v o„��A ✓ C�«.._(L- � G 7 3 �vP �wr,���l,�� � �rY rc.ff , .J/1 9 �Z� i �/z �= 3 J C -��� <br /> Owner Mail Address C ly Slate/Zip Phone <br /> Fw�, �-� � (� •,.�.� ���� �vc �� F_.K�,,N� ,.in y�b� �' S �/2 s--3s7, ll S <br /> TenaN Mail Address City Stale/Zip Phone <br /> /I '�1-5= i�8'i- 5�U/ <br /> i q 1n�- �o��-a✓ L�c_ 7 r 7 o i�� G G K /�v'c �n1 e�F�, lvl un.t/C.� �.E•-✓.�-, l�✓/1 ��U f3 <br /> [lecirt al Conlractor Mail Address Ciry � Slale/Zip Phone <br /> LICGNT ���`�5.�� � 37 �5. - <br /> State License Number Contrect rice of Work <br /> �+ow�vi.< .-c.�._� t>t�-.�/ K�ck� �.��cd� �J�l - 7$ `f- �-%op <br /> Proposed Use of Buildinc� � Contact Person (Plan Review) <br /> Description o(Work to E3e Done: /��c�,c� ���+��=S '� ��✓��'�- �����'— <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 /> 1 hereby certi7y fhat I have read und examined fhis application and know fhe same lo be frue and <br /> correcl. All provisions o/la�vs and ardinances governmg this type oI work will be cornpleted <br /> �vhefher speci�ied herein or noL The granfin9 0/a pernuf does nof resume to give aafhonty to <br /> violate or cancel the rovisions o/any ofher sfafe or local law reguPting construchon or fhe <br /> per(ormance ol cons�ruction. Thel I am authorized n��the owner o/fPos property to perform fhe <br /> work lor wl�ich applicalion is mnd�and 1 complV wit"i��ie State ConVaclors Law 18.27 RCW and <br /> 296.200 WAC. <br /> � _ _� <br /> ��� ';�� � 1- - 2- � ' `(�� <br /> —3 gnature �� Date <br /> � <br /> `'a� `//di <br />