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,; <br />� 't.; <br />� <br />��-=���� ' ELECTRICAL PERMIT APPLICATION <br /> Y ..,p,.i. � . <br />� ._ �> ; CITY OF EV�RETT PERMIT SERVICES <br />���.. 3200 CEDAR STREET, EVERETT, WA 98201 <br />� `' 425-257-8810 - FAX 425-25%-8857 —www.everettwa.org <br />� <br />� .,l' -+..�' pPPLICATIONS AR[ACCEPTED FROM 8 AM TO 4 PM <br /> � <br />�. ^t;?�. _ -- <br />� � � � �. i r- )f� � � <br /> .'i � C.. �-' �� � J ( � !�J <br /> PROJECT ADDRESS <br /> ,) 11 cl;!S C�= �!`IlU � �'�t= `�If: ��.� �/i� ; � � �� [ �'�;:'� iT �,��� ,1 <br /> Owner Mail Address Clly Stale/Zip Phone <br /> � �c�= -2�/2 - 27 I <br /> Tenanl Mail Address Ci1y Slale2ip Phone <br /> ( �.��; 0 �� �- c�r�' �� ( C C`C i�i�1� �� ��30 �7��1r1�ic LJ L �tiiuulao J cJ H � �p� � '� <br /> + �-rr:^�- Eleclrical Coniraclor Mail Address City SlalelLip � Phone <br />� { �25 �5'Z ' o�"% �i � <br />� �' ( ��C' C�� 1) � � S I Z � C� �� �����GO. G � <br />� '-! State License Number Contracl Frice of Work <br /> Proposed Use of Building Conlact Person (Plan Review) <br /> Description of Work lo Bo Dono: �� t� �� ���C L� �- X 'T S � =�� ���� f� °� � <br /> � ; _� i H ilJ �`z� / Z S� v� U-, l' /�li�.�`�v �i2���r �—e« r�`i��v�- < <br /> NOTE: WIRING IN �JON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RAGEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 here6y certi(y that I have read and exarnined this applica(ion and kno�v(he same(o be Vue and <br /> conect All provisions ollaws and ordinances govenung this fype ol�vork will be canplefed <br /> whefher specified herein or noL The granting o/a pernut does not resume fo give au(honty to <br /> viola(e orcancel the provisions o/any ofher sfate or local la�v reguPting construc6on or the <br /> perlorrnance o/co%sfructron. That 1 am authonzed hy the owner o(this property to perfonn the <br /> work for which application is made and I comply with the State Contractors Law 18.27 RC W and <br /> 296.200 WAC. � <br /> �'�� � ' � > `7 C� � <br /> � i � �� , > ." <br /> (��,�_.. �� �_ ; : <br /> -- Signature Dale _ _ <br /> � ,"� , _ I <br /> � �� �� - <br /> — �� <br />