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; <br /> 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 AC(:EPTED FROM 8 AM TO 4 PM <br /> 112Z1 S � LJ� \2 ( �\ 1�F 12� f�n <br /> PROJECT ADDRESS <br /> C��y ��` [�i•itC'TT �10� CC0�1R JT�'�zb'� /- JFrZL-'TT �:,r#��jS1cl Y2i-zS7- �S�l (1' <br /> OWner Mail Address City �ta�e2ip Phone <br /> �' 1'RC 'j\ V`�T1�ti1 t�i� `�� <br /> Tenanl M1tail Address City Staterip Phone <br /> �,o�2K \� 3r ( c���U�T�I� �Y � �TY oF CV�2iT'f" f� ,Ccr � . <br /> Eleclrical Contractor A7ail Address Cily SWte2ip Phone <br /> �j�rC • CO <br /> State License Nwnber Conlrecl Pnce of Work <br /> j1&[ S 1�`i I >�, ��Q `�I "�u�r �J 5 �1��HEZ <br /> Proposed Use of Duildin� Conlacl f•erson (Plan Review) <br /> DescriptionofWorkloDeDone: ���\ (�F -!\�� �Z ���'�- '`\ 1�`1� �T� � 'y - ���� <br /> �I\��" ll�.l NO � <br /> NOT[: WIRING IN NON-DW[LLINGS IS REQUIRED TO FEE <br /> 6F IN RAC[WAYS, A4C OR AC CABLE. <br /> CITY OF EVERETT LOCAL SAL[S TAX CODE IS 3105 <br /> 1 hemb}�certi/}�fhaf I have�ead anJ cx�mi:ied this applicalion and know the sanie to be frue and <br /> correct All provisions��lla�rs m�d urdinances governing fhis type o��vork will be complefed <br /> wheflicr specdied hernin ar noL The gr.3n(ing ol a pernvl does notl�resume fo give authonq�fo <br /> viol�ite or cancel fhe provisions o(an}�ofher sfafe or local7aw regu afing cons�rucfwn or Ihe <br /> perforrnonce ol consuvc(wn. Tha(I am authorized by fNe ownar o(Ihis property fo periortn fhe <br /> work!or n�hir,h application is made and 1 compl}�n'i�h the Sfafe Contracfors Law 18.27 RCIN and <br /> 296.200 WAC. <br /> /7 " �' <br /> ��:��,��� �, ��- �I���1/,���� <br /> � 9gnaluro � Dale ' <br /> �(� �O�i-C��R <br />