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1 � <br /> ELECTRICAL PERMIT APPLICATION <br /> CITIr' OF EVERETT PERMIT SERVICES � ` �a �o� <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857-www.everettwa.org C 0 �� �- �� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> �,j �'�"J <br /> � �� i / ��.���' .. <br /> � � �/�- ��� � � ,- < �r� /�._�CS � �;• <br /> � � l;rz � <br /> PROJECT ADDRESS <br /> > , ���C (' � 72 ` yLS S�< </`� <br /> }'J,al�1/Ll�c�2 �S�{ i�tiV� .�:�i.. (� (_;�.�y � � � �( �/�CIIG.N�C�� cc-Y! . �G �� /b u <br /> Ownef � Mail Address Ciry State2ip Phone <br /> IN r� <<- ' rlh�rc �''L ,:�cl_. <br /> Tenanl Mail Address Cily SlatelZip Phone <br /> ;_] �� ��:i2V�c li ir� F�� %f�i�' � �yF��•I-�� SiLG�bc:1F,l� l�/1 ��' Z�/� 7�(� � �G� C�j 0% <br /> Eleclrical CoGtractor M�il Address � Ciry StatelZip Phone <br /> G �' <br /> � � �. S�.ti y l�Zl L h/ ' ; S ���� <br /> Slate License Number Contracl Price of Work <br /> I� �<. �1 1 l_ �)1 C l� SC�^��Yl-�✓ <br /> Proposeo Use o(Building Contact Person (Plan Review) <br /> , � � �, i l (:i � 7 (� <br /> Description o(Work to Be Done: / /-'�'-'/) I'- i //")/ �ve �1 7�L c. � <br /> � <br /> ��I L(J C c'.L'/.i. j'71 � C C- G��� 1.� �% ���;�L 'o-vJ�S S � � �L l I� / <br /> � <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br />� CITY OF EVE-RETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceriily(haf 1 have read and examined this application and kno�v Ihe same fo ba Irue and <br /> conecL All prowsions o(laws and ordinances goveming fhis(ype ol�vork�vill be complefeci <br /> u�helher speci6ed herein vr noL The�ranfing o/a pennd does not presume tn give authorify to <br /> violate or cancel fhe�rovisions o!any ofher sfate or local law regulating consfruction cr the <br /> peifonnance oI construction. That I am authorized by fhe owner o/this property to perforrn fhe <br /> �vork(or which application is made and!comply wiJi fhe State Contracfors La�v 1827 RCW and <br /> 296.200 WAC. <br /> �_. <br /> ".�� �) l � i ' _ .� <br /> �,�� � -�-�-�-��-- �� �� % �� � `� ' 8 <br /> Sic�nature ( Date l� <br /> � �� : �C��' <br />