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ELECTRICAL PEI��►iiT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />-025-257-8870 - FAX 425-257-8857 - v✓ww.everett�va.org <br />APPLICAI �ONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />h'3 � cv�.Ttiro�t= n�� <br />PROJECT ADDRESS <br />3 �a�- �3 <br />� i3o3 --��7`� <br />ar�K� e��i�R yai R����r-��..�t r-vLaL(1 Wf� 48z�� Y,�s Zss-�ob� <br />Owner Mad/lddress City State/Zip Phone <br />Tenant <br />Ma�l Address <br />�yc.v�u i � %�EcrR/C eo <br />[IedricalCon�ractor t.7aJnddress <br />�/cviNr�coo3 N� <br />Slate License Number <br />Sr� <br />Proposed Use ol t3uilding <br />Square Footage (II residen6al new cons�ruction, remodel or addition) <br />Descriplion of Work to De Done �' AiEW C�nC�t�l S <br />Gty <br />Cdy <br />SlaielTip <br />Statc�7_ip <br />Contrncl Price of Work <br />Contact Person (Plan Review) <br />�•�J W T I- Gli� l� u 2�IACA� <br />Phonc <br />PhonC <br />_/��TeQ�n (�`�2cu�T1 f Bn1HR�Ns - 2 cr�w�uc i i'RNs z-2r_c �ic,Nf;; � SwiTcN�S�_ <br />�- <br />cNrR -iH�t1.- a�tin�iNb v- su,�r4lei y��W+r�Ti <br />f1�MOJ1_ 1�%SIS11N�o fnLF-CI R� 1.1, /f�=�� <br />NOT[ WIRING IN NON-DWELLINGS IS REQUIRED TO <br />BE IN RACEWAYS, MC OR AC CA3LE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />! herr.by r,erbty fhal I have read anJ ezantined lhis apphcation and know thc sarne (o be fnm and <br />conect All provrsions of laws and orNinenCes govemurg fhrs type ol roork wrll be cornplelr.J <br />whelher spccdled hercin or nof 7hc gronfing ol a pernul dnes no( resumr, (o �rv� aufhonty fo <br />violnte or cancel (he /nnvisions olany olher slale orlocal lmv reyuPling conslnic6on or fhe <br />pwlonnance a/consfrucrron. �haf 1 am aulhorired by (he oknerol flusp roperty fo pndorm !he <br />wo/k lor which application rs madc and I compty wilh Ihe Sla(c Conlrac(ors Law 1H.7.7 RC W and <br />296.200 WAC. <br />w��� 3-Z7-I <br />5ignatu — —._—_— Dalc <br />FEE <br />��. U(� <br />���D�j- ��� <br />