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`�� r.� <br /> V Ea1�sN- G.C� . . <br /> � 9 y d 7-'ytl� ,.' <br /> ELECTRICAL PE�MIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CcDAR STREET, EVERETT', WA 98201 <br /> 425-257-8810 - FAX 425-257-8857—www.evereriwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> r` <br /> ���� ��. <br /> (,�n l `{ L S T — Fr ns i H c.�-o.t n�ur ri,� <br /> PROJECT ADDRESS <br /> �1C�-� �o r.� � �'�)/ y�si Ec.��2C� �'Q �'��ii <br /> Owner Mail Address City State/Zip Phone <br /> �S � �C: <br /> Tenant MailAdOress Ciry State2ip Phone <br /> t1 Y��"�J�1 �(�: <br /> � � �JFt�RSi CCi,c7 C:`UcrL�7J wE � �G/ i� <br /> Electrical Contractor Mail Atldress City Stare/Zip Phone <br /> S-EF}' (-(-l.-f� f D R 9 �l�� �.2g0, o v. °-. <br /> State License Number Cont�act Price of Work <br /> %/Z L1/i✓��' <br /> Proposed Use of uilding Contact Person (Plan Review) <br /> Description of Work to Be Done: � S�� No�'7y — %�1lJ7td c� �a�,, L�q��f� i iyy7�� � �✓�, <br /> 7L�51- LJa�- l�tJN�L S . �9n- )C/=n-,�- <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> � �� yss�a' <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certily that I have read and examined this application and know the same to be true and <br /> correct. All provisions of laws and ordinances goveming this rype o(work will be completed <br /> whether speci(ed herein or noL The�ranting of a permd does not presume to give authonty to <br /> violate or cancel the provisions of ary other state or local law regulafing construcfion or the <br /> performance of consWchon. That I am authonzed.by fhe owner of this property fo peAorm the <br /> work for which application is made and I comp/y wdh the State Contracfors Law 18.27 RCW and <br /> 296200 WAC. <br /> � l/���2�` / /�� � S ^ � <br /> �Signature Date ' -" J <br /> � / <br /> � �j f> <br /> :l_ <br />