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i <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 32U0 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857—www.evereriwa.org <br /> APPLICATIONS ARE ACCEPTED FROM S AM TO 4 PM <br /> ��� � � � ���11 y�f/C. �, �, �t"j�j ��Pi�I�' <br /> PROJECT ADDRESS <br /> Ownef Mail Adtlress Cily Slate2ip Phone <br /> PAp� ����phky ra► �� �r S��a t� ����� . �l�Zd�F 31z�-�9�a <br /> Ten.•nt MailAddress City Sla�e/Zip Phone <br /> %�lz V�f Y �1��, 5� E . u;c��z� ac�. ��21�ir , C�. 9��3 360•�Ss� y� <br /> Electriral Contractor Mai�Address ciry State�Zip Phone <br /> D� N� s �Ero� ��v -�Y" /�{60, vo <br /> State License Number Contract Price of Work <br /> ��aA m�� ���s <br /> Proposed Use of Building T Contact Person (Plan Review) <br /> Description of Work to Be Done: �L� Qi! e Y ���G�� L � C7 • Z��'7"'�� <br /> ��1 � .(/l �' fo )�c�cJ2 �dG/l�ro/1 S _ �1�12s LffSl C�itS{9e <br /> OF"�rCe P�o�lP �o�2D <br /> NOTE: WIRING IN NON-DWELLINGS IS RE�UIRED TO FEE <br /> BE IN R,4CEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby certily that I have iead and examined this applicalion and know the same to be true and n,� <br /> coRec[ A/l p�ovisions o/laws and ordinances governing lhis type olwork will be completed '/f <br /> whether spea/ied herein or noL The granting of a perm�t does not presume ro give authonty ro �� f � <br /> violafe or cancel tbe provisions o/any other stato or local law regulating conshuchon or(he <br /> pedomiance olconstruchon. That I am authonzed by the owner of this property ro pedorm the <br /> �vork/or a�hich applica(ion is made and I compty wdh the State Contractors Law 18.27 RCW and �) <br /> 296200 WAC, � <br /> � l V(� ���!/'� ����� �G — <br /> Siynature Date <br />