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ELECTRICAL PERMIT APPLICATI�JN <br /> CITY O�F EVERETT PERMIT SERVIC�S <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 1 �� �( <br /> ��> � ; , � 3 �;� � , r-U���. �� <br /> PROJECT ADDRESS � <br /> yz5 -z3g -`�So. <br /> I .J;)/1✓ia _t� !IY�r� :O.\ �hii � /_ .)r� %I � � �I//Pol/ L-�r� . GlF;l `� f <br /> Owner Mail Address � Cily Slate/Zip Phone <br /> Tenant Mail Address Cily Slate/Zip Phone <br /> � �� �f2� -Ci47� <br /> '��iLUi4l(.',�A i��1r-��;( ��� L��09n�C�n� �n: . ,�U� Itl�q�dv1; i'�,� _ �h C � ) <br /> EleCtriCal Contrecbr Mail Address Cily State/Zip Phone <br /> iz�i���7 <br /> �T)U�{-!Uc �'- �� `,r> � U �f�'`f��0. �0 �- ��"�,x <br /> State License Number Contract Price of Work <br /> /' �—�� ���i '� �����I;�` �'' �'��l-C� 7�� <br /> `� ���. � i <br /> Proposed Use of Building Contact Person (Plan Review) <br /> Description of Work l0 6e Done: )'� !�< <; <% �P 5 i�i% � n , J ;i ;, f m-��.:� � �C,�1�4" <br /> _ � i `r <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby certilv(hat I have read and examined this application and know the same to be true and <br /> con�ect. All p�uvisions ollaivs and ordinances goveming this type ol work will be complefed <br /> whefher specdird herein or not The grantinc�o/a permd does not presume fo give authonry to <br /> violate or cancel the provisions of any other state or local law regulating construction or the <br /> per/onnance ol construc,fion. That I arn authonzed by fhe owner of this prooerty to pedorm the <br /> work tor which applicafion is made and 1 comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> ! �' ' I Jf / <br /> I � <br /> _ � �iiJA � � :it�j�, ��J� � '� fi <br /> '-S�gnature ' t ( Date <br /> � UGv� -)`fU <br />