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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 � ... il `-�6 <br /> 425-257-8810 - FAX 425-257-8857 -www.everettwa.org <br /> � 0����ou5 <br /> APPLICATIONS ARE ACCEPTED FROM 8 Atd TO 4 PM <br /> � �� 3�3 /i ����� S� S��,�� !G3 <br /> PROJECT ADDRESS <br /> �/ �/d�u z� ✓ <br /> Owne Mail Atldress Giry State/Zip Phone <br /> o���� l� '%�;,��i�"J.D io37 3 /r��'/���SE Sk,�e l03 F���-� rI C�/��Z-� <br /> Tenanl MailAddress City StatelZip yZ�3�'f ZlnJ�one <br /> ����� ��fC`•, 'c, �e � � /�o,e Z2 �/ 7 � �/.>/1 cd6GG �� �o� 1GGS"�/�- <br /> Electri al CcntraC�or Mail Address Cily State2ip Phone <br /> 6� <br /> _�___,/�L� /��r G'v �� /� ����� �.�. <br /> Slate Lice�nse Number Contracl Price of Work <br /> ��`� <br /> Proposed Use o(Building Conlacl Person (Plan Review) <br /> Description of Work to Be Done: �//Socc // ���!� l�/7/�� C�lG K.i O d'o� X' �L� <br /> / . <br /> i'!/lGC_L, i7�f� 'L �d`1rf/v/ ,_�i i r ��l Gi <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> i CITY OF EVERETT LOCAL SALES iAX CODE IS 3105 <br /> I here6y cerii(y fhaf 1 have read ard examined this applicaficn and know Ihe same to be true and <br /> conect. All provisions o(laws and ordinances govemmg this type o/wc�k wil.'be compfefed <br /> I whefher speci6ed herein or noL The granling o/a pernut does nof resume b give 2uthonty fo <br /> violate ur cancel fhe provision�ol any other sfate or local law reguPting construction or fhe <br /> perfo�ntance ol const�uchon. That 1 am authorized by th�owner of fhis property to pedo:rn the <br /> work for which application is made and I comply�vifh the S(afe Conlractors Law 18.27�4CW and <br /> I 296.200 WAC. <br /> � � <br /> .=�.�r������'� �/�p/�� b�" <br /> —"� Signature -'Dale ,/�n <br /> / ri 11� <br /> \/•, <br />