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��yi'�.�!'L. <br /> ��Y� <br />:'itf. '�Y.'�i','{ <br /> x��'`` EL.ECTRICAL PERMlT APPLICATION <br /> , �, :, <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, VVA 98201 <br /> 425-257-8810 - FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CkEDIT CARDS ARE NOT ACCEPTED <br /> C ��T z� �lo; �1 ��'' s-r sE <br /> P�OJECT ADDRESS <br /> � S � f"ar I� C! Cc, c _ <br /> Owner ' Mail Address City State2ip Phone <br /> Tenanl Mail Address Ci��� State2ip Fhone <br /> j �?6�l <br /> ��teo�ti, �'l ,�� r � �e � �(r2 `( (r-�.a f ���er � ��,��� 6JR `1 �lu13 � � i� �S �Z <br /> Eleclrical Contraclo� hlail r�ddr�ss City Slate/Zip Phone <br /> �l��� n N'�C�� �� � ni�l <br /> Slate License Number Conlract Price of Work <br /> / . / <br /> c S � .Lt,l"�, �, - <br /> Proposed Use of Building Conlact Person (Plan Review) <br /> Description o(Work lo Be Done: ✓�' ���% (��•`^P W� f � ✓��_ <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE � <br /> BE IN RACEWAYS, MC OR AC CA5LE. <br /> CITY OF EVERETT LOCAL SALES TAX COUE IS 3105 <br /> � I hereby certily Ihat I have read and examined this application and know the same fe be true and <br /> correcL All provisions of laws and ordinances yovernmr�this typa o(work will be comp/eted <br /> �vhefher soecilied herein or not The granfin�o!a penret does not �esurne to give aufhonty to <br /> violate or cancel the�rovisions ol any other s;ale nr loca�law reguPlinp construction or the <br /> per/onnance o/conslrucfion. That 1 am aufhorized 6y fhe owner o�this prope.4y fo per/orm the <br /> work for which applicaCon is made and/comply wifh the Sfate Contractors Law 18.27 RCvV and <br /> 296.200 WAC. <br /> /f/ <br /> i % ` ZZ - u� <br /> °'�ynature c Dale <br /> i � ? <br /> r•,�/�!� "- �_1 � <br /> �—_' ---_ ' <br /> , J ' lo . . ._ . .,r <br /> � '�y! 1 �' -t r'r ' 4� .' <br /> � �� �� R � � � � t `� - : � . <br />�t . _ {�R� l '.:` <br /> t'` �,.t � _,�`� @ J�p '�( � � i .r re. y '�1���) ��i <br /> '<, n �� �g } rif 4 Yk : G � f� �.. -� w r �i <br /> .C: . !'. . t f� 4�. .S4ia s . . _-. ._ .. ES-: _ . 1S'a ' `I . .. <br />