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ELECTRICAL PERMIT APP�ICATION <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 ACCEPTED FROM 8 Afl1 TO 4 PM <br /> �i�/ � S�Nr� j1 I4�% LVr�., 11 GJ� �1�:..i <br /> PROJECT ADDRESS <br /> 1a2S -7'i` . <br /> ' - <br /> �E �� 1�vl:a.�,; (c<C �ii;ivr.� � )'1� 7n�. ��, /� � G /ir�>f �1V :�>( y7" SS <br /> Ow r A1ail dress City Slate2ip Phone <br /> Tenanl A1ail Address City State2ip Phone <br /> C✓.Y���G�� $. c . ,'i �� 5�5/[p5 7k3 !sf ` # `IS !Sv lc�..- � . S- <br /> � ��. 5 5<<r iG � ,i c. <br /> ElecUical Contracloi M11ail Address Ciry Statc2ip Phone <br /> (,�'�6'/1i5� �-v,�.rl 5� '� 3 3 k5 <br /> Slate License Number � Conlract Price of Vtbrk <br /> i:.!.�;li ,i. n��nL {crilu.,.. . ���PN �`Cl� <br /> Proposed Us� of Building Conlacl Pcrson (Plan Review) <br /> Descriplion o(Work lo�e Done: �41,(, I ��� �- J �.� J)��{��.,,•, L��y,� Z (� L,�� <br /> c <br /> �i'II �J.CI•� Ir =� �l. I��t�il�t �� .r VL,nv, �r:l <br /> _r1-l., <br /> 1 J' <br /> NOT[: WIRING ItJ NOIJ-DWELLINGS IS R[QUIRED TO FEE <br /> �E W RACEWAYS, MC OR AC CABLE. <br /> � <br /> C!'. �F EVERETT LOCAL SALES TAX CODE IS 3105 <br /> !hereby ceriily fhat I hare read and ez�amined fhis application and kno�v fhe same fo be true and <br /> corrocL All provisions ollaws and orxiinances goaenung fhis type ol werk will be complefed <br /> trhe(her spealied herein or noL The granfing o/a perrnrt does ne( �resurne to give authonty to <br /> violafe oi cancel the provisions o/an��o(her sfafe or loca/law regulating construcfion or fhe <br /> perlornt nce ol conslrucfion. Thaf 1 arn authoiized by fhe on•ner oI tl�is property fo perform fhe <br /> work lo�whicli applicafion is made and I cornply n ifh fhe State Con(iactors Law 18.27 RCW and <br /> 296.2 � WAC. <br /> r? 7 yc� <br /> � �, /�, �����_ , .. <br /> �L <br /> Siqna�ure Date <br />