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ELECTRICAL PERMIT �►PPLICATION <br /> CITY OF E`JERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810 - FAX425-257-8857—www.everettwa.org <br /> APPUCATIONS ARE ACCEPTED FROM 8 AM TO 4 PM -DEBIT 6 CREDIT CARDS ARE NOT ACCEPTED <br /> �9�?G od3""�/�oe�r�.� .Sz�. .��� <br /> PROJECTADDRESS <br /> �i/l�L,��-<e �'f>,,` �•: .5� �U I3nx ly/ 7%�,� . � -// ��8�� <br /> Owner MaliAdare:s Clty Sta[e21 n Phone <br /> vL�'�u T/Yd7 <br /> Te�n/anl� � Moi�AEErcss Cily State2ip phone <br /> f_���U/ �l.��i �C/JG$ 1.uc. <br /> �4. �_�i�.� �/,c fe�z� F�G. ,C�ax /X�� `7��,;,�,.5,,;//f G� 9�7x> <br /> Electrical Contractor Meu Aatlress Ci�y State ip p�yo�n�e�� <br /> �''0�v-s—%YISJ <br /> ,�`I�R ur�r 9v i��s �,���a- <br /> State License Number Contrect Price of Work <br /> �5��L .�A�G� ( !�F/�i P.�f"-Ua�i/ <br /> Proposed Use of 8uilding Contact Person (Plan Review) <br /> Desaiption of Work to Be Done: cS � . p �• <br /> � <br /> NOTE: WIRING IN NON-DWELIINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I he/eby caMily thaf!have read and examined Mis applica6m and knaw the same to be tae arM <br /> �comect. All provisions of laws and ordinances goveminq this ty,oc of wak wil!be complefed <br /> whetherspacRod herein ornoL lhe g�antirg o(a pertn�t does nof presume fo give authoMy fo <br /> violate or cencel!he provisions ol any otfrer sfate a foca!law regulating conshucNon or tha <br /> peAormance o/construclion. That f am aufho.�zed by the ownero/Misp roparty to peAam fhe <br /> worJr/or which application is maAe and!cromplv wiM�the Stafe Controdors Law 18.27 RCW and <br /> 296200 WAC. <br /> e�' ' �//���/7�/�C 'J/�i5� <br /> SiBn ure �' p��� <br /> l <br /> (� (� " 7�� <br /> ,� ' <br /> Z 'd bESBES909E o?�zoat3 uoczoy aTi �OT 50 EI ��C <br />