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ELECTRICAL PERMIT APPLICATIf�N <br /> G�TY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 � �a0 �V <br /> 425-257-8810 - FAX 425-257-8857 -www.everettwa.org �f �� V�,�, L <br /> ,.� <br /> APPLICATIONS ARE ACCEP�ED FROM 8 AM TO 4 PM <br /> � 31�� a��-�'� 5��. E ��� �(��-� , �v�r G'���-01 <br /> PROJECT ADDRESS <br /> Jwner Mail Address Cily Stale/Zip Phone <br /> k' � n S��'v ��S 13L��UJ " 5t� ��r�-t�- w l� � �'��3 4a5 -�5a �o� <br /> Ten�nl Mail Address Cily —r State/Zip Phone <br /> ( lP�� l�,� �e��FY� �1�11 '-1 C:rrc�nr� F'1v� . �Jece-4-� (,�� °�F�� 4a�-�yo-3i � <br /> EICcUi��ac�ot A1ail Address Cily Slale2ip Phone <br /> LLt�.� ��-�c1�1C��J ���lin��3 SSy�i . �.I . <br /> Slate License Number Contract Price�(Work <br /> C�"��i cL. <br /> Proposed Use o(Buildiny Conlact Person (Plan Review) <br /> 1 I (I <br /> Description o(Work lo de Done: �I'�5'�< < ( l�� `� S <_t 11(l (1� C� <br /> � 'i-�iE�Ci� v L� � i�T�,—��� � � ��' ��ure �11� �c l I <br /> I���-�4fi�, r�� ���r�� �� r, � ���_ ��I,� r������c�� . i�d �� a � ��rcu ��1's . <br /> NOTF: W IRING IN NON-DVVELLINGS IS REQUIRED TO FEE <br /> BE W RACEWAYS, MC OR AC CABLE. i �U'S� <br />� <br /> I CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 t�ereby certily tha(I nave read and examined this application and kno�v the same fo be true and <br /> ccrrecL All p!ovisions oI fa�vs and ordinances governinc�fhis type o(work will be complefed <br />� whefher specdied.'ierein or noL The granting o/a pernut does nof resurne fo give authonty to <br /> violaleorcancelihe�rovisronsolanyolherstafeorlocallawreguPtingconstructionorthe <br /> performance o/.;onstruction. Thaf I am authonzed by lhe o�vner o(this property to perform the <br /> work lor which application is ntade and 1 cornply�vi8� the State Confracfors Law 18.27 RCIN and <br />' 296.20u �jVAG. � •- <br /> � �'� � ��, � �� � � 2 <br /> '' ' 4 <br /> � . , , �_ � _ � a � aq i <br /> , <br /> ��_� l a ��t( —l��l�.� � � 1 <br /> �- ��SignaWre - . Oate � <br /> i <br />