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ELECYRICAL PEFtMIT APPLICATION <br /> CITY OF EVERE7T PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 -www.everettwa.org 3- a 6-o g <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> �� QO3—��`� <br /> _j D 3 l .5 I ('-�- �., l•�� S � -� l � �, <br /> PROJECT ADDRESS <br /> ��6 7`�S� -�4�sS <br /> �+ c�-� � u lJe�4 ID3iS (S'-}I.. Klur S� �/ob � �:c+-F�-'►� 5��?.v� <br /> Owner Mail Address City State/Zip Phone <br /> Sc� � . <br /> Tenant Mail Address Cily Stale/Zip Phone <br /> l,�`I �G�' �( �-{'�<�� � 1��J L��Jc��t� �_� l��c s[�tl..c�-w's � ��� lg��`i0 3Co- s68-2o,� I� <br /> Eleclrical Contreclor Mail Address City StatelZip Phone <br /> /�Kl� �C �C �i6S �Ur!' �`�cSG� �Uc7 <br /> State License Number Contracl Price of Work <br /> d � <br /> Proposed Use of Buildin� Contacl Person (Plan Review) <br /> Descriplion ol Work l0 6c Done: /r�r��-\ � �-�'��� � S Z�( Zk� ��0:-<6'��� �-� E�S <br /> _� c•�c�'{' ��G '�-- Z CCIJ L'CI �-Lr�cc. �'c,l� <br /> � <br /> NOTF: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN R4CEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> i hereby certily fhaf 1 have read and examined fhis application and know the same to be true and .r— --> <br /> corroct All provisions ollaws and ordinances govemmg this type of work will be complefed �Ou�U J — /�y <br /> whether speci6od hereir or noL The granting ef a pemuf does nof resume ro give authonty ro <br /> violate or cancel the�rovisions o(any other state orlocal law reguPting consfniction orfhe <br /> perfonnance o(construction. T7iat 1 am authonzed by Ihe owner oRhis property to pedomi the <br /> worh for�vhich application is made and 1 cornply mith fha Srafe Contractors Law 18.27 RCN�and <br /> 2y6.200 11�AC. <br /> ��'��%.�` _ � - � G —v 3" — <br /> Signature Date <br />