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� � . <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERViCES <br /> 3200 CEDAR STREET, EV_RETT, WA 982�J1 a—8�I I <br /> ;2r257-8810 - FAX 425257-8857–www.everettwa.org r//D � `�� <br /> L <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> ' o :�n� - ,������( ���, ��1 . <br /> PROJECT ADDRESS <br /> OWnef Mail Address City StalelZip Phone <br /> 1c�u �ci« �o�c(� ��ti c( h�� ��� 5��� �c I bC� ����c�r�l ���'1 l��B' <br /> Tenant' Mail Address City State2ip Phone <br /> Cc�� �i � � �l , 11�� c� , �(� �� � �33j�z.�� S�a-I{- I ' tC}t4 �'I`61 �» <br /> Electrical Conirector Mail Address City Slate/Zip Phone <br /> � � IkI � l��r> 'S� °(����Lc , r� Z� <br /> STa�e License Number Contract Price of Work <br /> _`3L'r-t-F �,i��Ll �lG�--� <br /> Proposed Use of Building Contact Person (Plan Review) <br /> Description of Work to Be Done: .�����tl � � "> Q�� t�.��, /� �)n 1/ � 4� <br /> '—� « L���I -I-�(%��_ - <br /> NOTE: WIRING IN NON-DWELLINGS IS RE�U!RED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CC.DE IS 3105 <br /> I hereby certi/y that I have read and examined fhis applic.3fion and know the same;�be(roe and <br /> cormcL All p�ovisions ollaws and ordinances govemmg fhis type o/wo�k�vill be comp/eted <br /> �vhe�'�er speafied herein or not The granfing ol a pe�md does nof p�esume to give authonty to <br /> viola�:�.or cance/the provisions ol any olher state or local law iegalating construct�on or fhe <br /> pedarmance o7construc6on. That I am aulhonzed by the owner ol this propeAy to pedorm the <br /> work/or which applicalion is made and I compty wifh the Sfate Cont2cfors Law 18.27 RCW and <br /> 296.200 WAE. / <br /> ' / .6 .�S <br /> ' :,��/ / d <br /> -�-�r"ra��l ,���;�r .� , �� � 0 <br /> SignaWre�� Date <br />