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r <br /> { <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 3 _ �-� _�Ci <br /> 425-257-8810 - FAX 425-257-8857—www.everettwa.org <br /> C- oSo3 -o�K <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> '�t���.ii �[�-h./:/1CC l�N_ '� � <br /> PROJECT ADDRESS <br /> �l— �1�—�-2rip <br /> L�tiS `-c�Gti �n �.���s �( y0r� ��rkr:ct�E" C�k'���� t-1,2rc-7 `'f,j')Jj �oL3�3'l�YJ <br /> OWner tdaJ Adtlress Qty State/Zip Phone � <br /> Tenant Idail Atltlress ��ly Stale2ip Phone <br /> �iNr�/1- Gtz7ti�� ?C�Ci�/ �S'c+Ft �R� ,v� /'rch%n�y,v GvR y,�'OJ�� Y�J�e�IZ7�� <br /> [Iecirical Contraclor Mail Address Cny Stale2lp Phone <br /> G i•v�'C�� J Y�L,6'lil U.� �j �u <br /> State License Number Contraci Pnce of N'ork <br /> Proposed Use of F3wlding Contact Person (Plan Rewew) <br /> Descnption of Work to�e Done ��� �� '""{'ti��`��� <br /> NOTE WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE <br /> CITY OF _�VERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 heroby certdy fh�l 1 have read and eaarruneA Ihis appbcahon and kno�v tbe same!o be fnre and <br /> corrocf All prov�s�uns ol la�vs and ordinances�overring(his type o/work wdl be complefed <br /> �vhefhe�spec�lied herein o�nof The grmr6ng ol a pernuf does nof presume fo grve aufhoriry to <br /> vrolafe or cancel fhe provisons ol any olher sfafe or local law regidating consfn�ction or the <br /> perlorrnance ol mrstiuction That I am aulhonzed by the ou�ne�o/(his property to perf�rm�he <br /> ivork lor ivhrch app6cation rs nrede and I cornpty�tvfh the Sl.ale Confraclo�s Laro 18 27 RC.Y and I <br /> 296200 WAC. <br /> ./j,���_� ����,� , / I <br /> Signal c Date /�,�� � / y ! <br /> il <br /> � <br />