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� <br /> ELECTRICAL PERMIT APPLICATIQN <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 ACCEPTED FROM S AM TO 4 PM <br /> ;r.5 � � �l ( � .�j / 5 � ��� t%Tl/ <br /> PROJECT ADDRESS <br /> � � r`� S�y�'� �t���'''�5 / z Y z- ,5��Fr- /'�(/� Gc>o�ysz�, /�> Gv.4 %���C� <br /> Owner � A1ail Address Ciry Statc/Zip 0 Fhone <br /> .� l�.j-j 75>$ <br /> Tenanl Mail Address City State/Zip Phone <br /> �iu �C�f� MiL�G7L ��l�(���P�STI�I�����1/hSv./' t"CJC) � �v <br /> Elecl ical Conlractor Mail Address Ciry Slate�Zip l/Z ,�� Ph�on� <br /> ! ��_V./ <br /> G�i�c, �i �-r � y.s"/��� �'lac� ^ <br /> State License Number Conlract Price o(Work <br /> Proposed Use of Building Contact Person (Plan Review) <br /> Description of Work lo D�Duna: /�f��� fv--v' r� � r���f' (fi_�l���T'�S <br /> NOTE: WIRING IN NON-DWC-LLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certily thaf/have read and examined fhis applicafion and kno�v the same to be Vue and <br /> correcL All provisions ol la�as and ordinances govemmg this type o/wo�k will be completed <br /> whe(lierspeci6ed herein ornoL The c�ranting o(a pennrt does not resume to give authordy to <br /> violate or cancel fhe provisions o/any ufher sfate or local law rec�uPting construc6on or the <br /> performance oI construcfion. That 1 am au(horized by fhe owner o/this property to perform the _ i <br /> work for whicl;application is rnade and 1 comply wifh trie Stale Contractors La�v 78.27 RCW and � <br /> 296.200 WAC. � �/ , / 1 S <br /> . J <br /> � � � �5 <br /> �!�/����-� ����d � <br /> SignaWre Da�e <br /> � <br />