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ELECTRICAL PERMIT APPLlCATION <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 8 AM TO 4 PM <br /> �I <br /> !l`i�J 'l✓� 1>�� c1'� <br /> PROJECT ADDRESS <br /> ��"4i1 �lll f �G�li� � � ( ��� ll I 2}"�(JY' ('E �� .Q�f'�- U�l(� ��2 �., <br /> (. �. n a, i y/� � t � of' �,�����_�rs <br /> Owner Mail Address Cily State/Zip Phone <br /> �J��s�� arr.A �'ar.i�,a� �os;� �- <br /> Tenan� MailAddress City SlatelZip Phone <br /> /, rr /, /� � <br /> �{:�1�(�Ia'e2� J('�IfYt`/!� �lu! 1 �� � �- ,�,�1L�C/I cl F I /�',(l�c� �u�H 'f f�IC�E QC(^ .1G� �74 <br /> Eleclrical Contraclo� Mail Address � V City Slate/Zip Phone <br /> �� '\!� <br /> ��, l��l �' ( �11� !_ K � � w <br /> Stale License Number Contract Price o(Work <br /> Propused Use of Building Conlact Person (Plan Review) <br /> Descriplion of Work lo Be Done: ��1,�7�•T �� ����L'�� � � ���� ��!'���'�, ���� �/�.J�� <br /> �%il/�<%11��Of�/i,�(t atf �C �I.YCi1"��7r;r �2{-{f� �� l2�lc� II� \l ,��� rxz{-Irrf} — <br /> � �N�t � <br /> �u�u�f� �'.� �,Ir:l��i(ii� �i;�ILt�c�i rlli i=.�.�'U,(i;� )9�'.itl1 )rf��' 2'eS� �I'lS��-ctilJ i1�W <br /> j1��2�105(-c•�t-. <br /> NOTE: WIRING IN NON-DVVELLINGS 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 certify(hal I have iead and examined(his applica(ion and know Ihe same to be frue and <br /> coirecf. �II provisions o/laws and ordinances governing Ih�s type ol work will be completed C((��:- �;i-7c.y <br /> whether specified herein or noL The granfing o/a permd does r.ot piesume to giva aufhority to I <br /> violafe or cancel the provisions ol any other stafe or local law regulating consfruction or(he <br /> peAormanco ol construction. That I am au(liorized by the owner of this propeRy lo perlorm the <br /> kork lor which applicafion is made and I comply with(he Sfa(e Contrec(ors Law 18.27 RCW and <br /> 296.200 WAC. <br /> n ') <br /> �� ' / <br /> / <br /> ;' ' / ;�����-- C?� _/�'/C', <br /> SignaWre `� `—� Date <br />