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�— <br />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 — v�nvw.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />J �i C �S � �'� I1'1 :Y1 � Y /tl'�'�— <br />PROJECT ADDRESS <br />3-�6-i3 <br />��30 3 -a� 3 <br />�3S 73�7 <br />� <br />j� i c�; 1 ti� ^-4'a �,. ��`�/ C� S•ti m rv� �- Q.,�- C.�::-�-i--1- �,v A 4 S'.�-c� I_?� 3�� <br />i Owner Mail Atldress City Statc2ip Phone <br />i � <br />I <br />I Tenant <br />Electrical Contrador <br />1.9ai1 Address <br />Mail <br />(7� rJri.�;Fi �; 3� er� _ <br />State License Number <br />'. Froposed Use of dmlding <br />Ciry <br />Qry <br />Stale2ip <br />�- 11' <br />Slate/Zip <br />Phone <br />� L'+0 �7`i`� �% <br />c�- �:.} /� %�•�'3 7 <br />Phone <br />/ C�t1 O �[� <br />Conlract Pnce of Work <br />����" <br />Q,t.�) :1 � L-1.�. .'\ <br />Contact Person (Plan Review) <br />�, Description of Worh to Be Done: L v� � � �� � `' `-"�� '� `�-'r �"''�"`� �-'� '�"`-'-�y�'"' — <br />� 1 � r .� S /2w � � �l c �l <br />NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br />I BE IN RACEWAYS, MC OR AC CABLE . � <br />r(; �;�, <br />I CITY OF EVERETT LOCAI SALES TAX CODE IS 3105 <br />' I hereby certi/y fhaf I have read and ea arnmed th�: applica(ion and kno�v the same to be lrue and �, <br />cor�ect All provisions olla�rs and orAinances 9overnmg fhis type ol �vork �vill be comp!e(ed �. (�jGi J- � 1, <br />a�hefher specdied herem or noL The granfing ol a pernuf Aoes notp resurne to give aufhonty fc <br />� violale or cancel fhe provisions o( any other state cr locnl law re9ulaling r.ons6uct�on or fhe <br />I pertomiance o(construction. Thaf 1 am authonzeA hy the owner o� Ihis p�operty to perform fhe <br />I work lor �vhich applica6on Is made and 1 comply �vR'i the Slate Contractors Lau� i8.27 RCW and <br />296200 WAC. <br />�a i :x-�.r,- ��� �- /.�-- 3-O/ 3 <br />Si�nalme Date <br />