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� * <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES �_ag_�, � <br /> 3200 CEDAR STREET, EVEaETT, WA 98201 0�08-�9 3 <br /> 425-257-8810 - FAX 425-257-8857—www.everettwa.org C <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> �1[�C1n11 �y�h UC . 5 . �. f�(izrc�L <br /> PROJECT ADDRESS <br /> c/%c1:c�.� ,� 5� i � 5�" �1 �� rr Lsv��«'7� � ,� <br /> Owner Mail Address City State2ip Phone <br /> S'>f ,..,t� <br /> Tenant Mail Adc�ross City Slale/Zip Phone <br /> �'N)/l�� f.���..f o� 1 ��}�r} l'{��t 'Jl%lC' (.t/✓�- �f`�A�- 3S7 i�J.7d'3 <br /> ElActrical Conlractor Mail Address City State2ip Phone <br /> Sw�� s'osc �i 3 1 K I �'� so� o �= <br /> Stale Ucense Number Contract Price of NJork <br /> G,�7 5�,�'`I_s---- ,N�,t<< V.�: I <br /> Proposed Use of Buiiding Conlact Person (Plan Review) <br /> Description of Work to �e Done: � ��e•t �� ne n-S eoC C �lC �.� ,? d-o.E Q....--�n "�u`fJ <br /> ( . � r-f %1 <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> � <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAY CODE IS 3105 <br /> 1 hereby certily fhat 1 have read and examined Ihis application and know the same to be frua and <br /> correcL All provisions o(laws and ordinances goveming fhis type o/work will te complefed <br /> whefher specified herein or noL The granting o/a pennrt does not resume to gi��aufhonty fo <br /> violate or cancel the Provisions of any other state or local law reguPting construchon or the <br /> perlomiance o/cnnstruction. That I am authonzed by the o�wier o/this�roperty to pedorm the <br /> work lor whrch applicafion is rnade and 1 cornply�vith the Stafe Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> _��%,�---- ��3`�J �� 7 � L' <br /> Signature Date � �_ / <br /> .� � 3 <br />