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,: ._ _, ,_ _ � /Y o/�{ <br /> �.�..�,�,,:�-.,.,.., ., .. . , . . <br /> _ cr-� 3o3�s <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 5 `i3��� <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org �l�/DCj `08� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> � � �D /�e.,r�-,�jl C�� �-Ic �c�� l�cwa .� �5 �„" �e / a � <br /> PROJECT ADDRESS <br /> 9d'/6 0 <br /> T'�e��i.c�D �c1G s �o� ��/� v c , /1/GJ �-1,ure�1, e �i� <br /> OWnef Mall Addross City State2ip Phono <br /> _/ �G`�I�— ( DvG / CG� C� p(��✓'�S'S) <br /> Tenant Ma�ress City � Stato2ip Phona <br /> � %`�h � �- � �� �7��;�J�aL� ���w� � 9�oX 7 <br /> Electrical Conlraclor Mall qddress G � StatelZlp Ptw�e <br /> �y y2s ;v3 97 � <br /> � /nl'�J �%-L 9/L"' � _3 �P � , /O a U= <br /> ` State Llcense Number Contrect Price of Work <br /> G_G/�� � /,�z�e ..,f �Li �_ �'�i �7� C r w � �r- <br /> Proposod Use of Building Conlact Porson (Pian Re ' �� S�� <br /> a-vd 73v d <br /> Description of Work to Be Done: �h t ��r ,Q� � i�t^ C � f/ -s/ /1—� C �� G�Y <br /> �OV'- �h V f ✓`U h ✓ti r -1'G�{' �4^'lGt _�._ (n L ,. �� � � Q� <br /> i � <br /> � ,� r � ,. .�� s �� h c � o /ti 1� � �Q .r- �8� �, �/T - u � <br /> / ' <br /> NOTE: WIRING IN NON-DWELLINGS IS RE�UIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> to� �. <br /> CIN OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> !hereby certily fhaf I have rood and uxamined this applice3tlon end know the same fo be fruo and � ' 4 O 5 _O �l <br /> corroct. All provlslons o/faws end ord/nancos govaming thls type o/work will6e completod � � <br /> whother specifled herein or nof. The granting o(a pormif does not presume fo glve authority fo <br /> vlolofo or cance!the prov/sions oI ony ofher afate or local law regulatlng consfrucfion or fhe <br /> penormence o/construction. lTie(!em authanzed by fhe owner o/fhls property to perform(he <br /> worl;lor which applica6'on is made and f comply wifh the SYafe Contrac(ors Law 18.27 RCW end <br /> 296.200 WAC. <br /> �� .�� � �� ��,�� <br /> STBnalure� Date <br /> /�S yy <br />