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i <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 2—/z —/0 <br /> 425•257-8810 - FAX425-257-8857 —www.everettwa.org ��O6z -,�69 <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 �M <br /> r <br /> �n� ��� v,�� - p�,���� �� ��va � . D <br /> PROJECT ADDRESS <br /> � � � �' �;';l%FI',('nnt i? �C /h(� NU1 � inmAn7�5� /,Uc/ I354,jiitA/� W 7SlI�� / <br /> OWner —�— Mail Address Cit� � SlatelZip Phone <br /> Tenanl A1ad qddress City StatelZip Phone <br /> (��- �/r%r�-�r I�11,��7 1:9J+��/_� Sf `1�,�n��ti��SrJ l,vf} �1S12.'7G � o •-�7y-7�i <br /> Electrical Conlraclor Nail Addmss Ciq- State2ip Phone <br /> �71�£c ��(�/.Tl �II.��I�� '��o <br /> � <br /> Slate License Number Coniracl Price of Work <br /> ���'ii9 i'.'It ( l I r 1 .� � ���%� j � � /-, <br /> Proposed Use of�uilding Contacl Person (Plan Review) <br /> Description ol Work to�c Donu: C(s���:, f�C�. /Ji?W i G �7'i Y����1 r ���'a7 C'�,c (�f0�'n<.n�/I (!-� r � <br /> t <br /> ,,.ca �SJ�°,✓, <br /> NOT[: WIRING IN NON-DW�LLINGS IS REQUIRED TO FEE <br /> BE IN RACCWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ce�tily that 1 ha��e read and exmnined fhis ap/�licafion and kno�t�the same(o be frue end <br /> cormcL All provisions o/la�rs and ordinances gevernmg flus type ol�vork irill be complefed <br /> whether spcaGed herein or noL The grantin�e!a pernut does nol �resumo to give autl�onfy lo <br /> viol�fe or cancel fhel�rovisions al any other sta(e or local law re�uloting consfruction or fhe <br /> perfonnance o/ca�siruction. That 1 am authoiized by the o�vner o(Uus properly to pedomi fhe <br /> �vork lor�vhich applicafion is rn�de and 1 cornpl}�with fhe Sfafe Confractors La�v 1827 RCIh�and <br /> 296.2001NAC. � <br /> ' – ;'i'��`—� .� –/1 –/D '�!1 <br /> ' SignaWre Date n ��'I <br /> ��� ��; <br />