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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 ACCEPT�D FROM S AM TO 4 PM <br /> vl^L�C_> tile.cri� � ( Ce c� (: Pk l.%�/ 5.,,4c_ �C1� <br /> PROJECT ADDRESS <br /> S� �., . � L�1- � C LL� - <br /> Owne� � Mail Address City State/Zip Phone <br /> Te«�.�� �0��0 � M �l LL C�� �n�`� �� /ov C-�I�-Pc=�7 <br /> l'enanl Mall Address Ciry State2lp Phono <br /> j n aer r �c'c;�c L 1S•� 2� �Sr� �V� (,t) �rn rw z,� 1�.� ��iCG7 <br /> Eleclrical Contraclo� Mail Addross S��•��'�� Ciry Slate2lp Phone <br /> , �� � N ��C- I �rlv�,`� �S�a = <br /> State License Number Contract Price of Work <br /> Proposed Use of Building Conlact Porson (Plan Review) <br /> DescriptlonofWorklo6eDone: '/ ��I l—c �"\ ' M���� -?) �"�z'"� ��Sc��n.ie��- J`Jfi <br /> NOTE: WIRING IN NON-DINELLINGS IS REQUIREQ TO FEE <br /> BE IN RACEV��AYS, MC OR AC CABLE. C <br /> �� •J � <br /> i CITY OF EVERETT L�CAL SALES TAX CODE IS 3105 <br /> 1 hereby certily thaf 1 have reod and exnmined this applicalion and kno�v the same to be frue and � <br /> correcL All provisions of/a�vs and ordinances govemuig this type o/�vork will be completed 1� I ��5� �� <br /> wltefher specified herein or noL The granfing o/a pernuf does nof resume fo give aufhonty to l�� ` � <br /> violateorcanceltho provisionso(anyotherstateerlocpllnwm�uPtingconsWcfionorfhe <br /> perfomiance o/construction. That I am authorized by fhe owner o/flus property to peAomi the <br /> �vork lor wt 'ch application is made and 1 compty�vith the Sfofe Confractors Law 18.27 RCW and <br /> 296.200 W C. <br /> � �� � � � <br /> � Dale <br />