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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 // `a��"O7I / <br /> 425-257-8810 - FAX 425-257-8857 -www.everettwa.org LC �"�//-�� y <br /> ! <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> � z �� S �y�, .� � �� <br /> PROJECT ADDRESS <br /> �r� Q � /���, .� 3 :� 3 5����� �c �r f�er�etl q� 2 � ( Cy�>-�a�i-Z6� <br /> Owner hlail Address Cily State2ip Phona <br /> S [i��� � <br /> Tenant A7ail Address Cily Slate/Zip Phone <br /> �YZ '� <br /> � H ���-`�(/`� C nr� �oX 2 `� S� Cl/er'��i W� � �J21 � 2i� - 3SS-3 <br /> [lectri. I Conireclor Mail Addrcss City SlatelZip Phone <br /> l,��i c= N � � y � 7 c� ��6 va �� <br /> Slale License Number Conlracl Price of Work <br /> `) r' �� <br /> ProposcA Use of�uilding Contacl Person (Plan Review) <br /> DescriptionofWorktoDeDone: (i' i e�� i 1 i'n✓�cao � �" �1��Ucc� CL`/`CA� <br />\ NOTE: W IRING IN NON-DW ELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CAE3LE. <br /> CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> I hcreDy caii!}�Ihat I ha��r read and exarnined this applicafion and know fhe same fo be frue and <br /> conrcL All provisions ol la�vs and ordinancr.s�overning this type o/work wiN be cornplefed <br /> �vhefher specilicd herein or noL The g�anfing of a pernut does nof restune to give au(honty to <br /> violale or cancel Ihe provisions ol any ofher state or local la�v reguPling con5iruclion or the ' I�}�_ <br /> peAonnance ol construchon. That 1 am autho�ized by fhe owner o!this property to perlorm fhe � <br /> work lor which applicafion is,viade and 1 comply with fhe Sfafe Con6aUors Law 1827 RCW and � <br /> 29G.200 L'✓%C I I <br /> i � <br /> `� �'(, �---��^ // �Z 7 �7 � �i <br /> -- Signalurc ,_, ate <br />