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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES 3 `lc��.07 <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857—www.everettwa.org �O�03�7l <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> 1/ � � `7 / `� f� �'r .S�o" — � - 107 <br /> PROJCCT ADDRESS <br /> /V �.. <br /> i l �l � <br /> ����\ � � %f .� �%( �1� � ���� � ; ��i :.i i' / --� i <br /> ���.;w���Diti ��.r � �� , �� J �.�..� �. ,l.��l ��r , ,,,� yz� 3�y ::�o � c� <br /> Owner ��dress Cit� StalelZip Phone <br /> � c�(�� i)� L.. L l, C - <br /> Tenan� Mail Address City Stale/Zip Phone <br /> /-l��— SF�V �c�_ ;�� ;�.ciY2� c_ /CaZo • ��rwcv , SNOhot7�5l� 1G7I,`f���6 Z�"SC�q�c'/o/ <br /> Electrical Contractor Mail Address Ciry Slate/Zip Phone <br /> /-} L(�S �fz"-y I 25�IJ l�/GO �-- <br /> Slale License Number Contracl Price of Work <br /> i � .-�� r� �cG� `22d-ta N <br /> Proposed Use o(Building Conlact Person (Plan Review) <br /> Description o(Work lo Be Done: l� (� I� I<i%�' �� �'�l �'t ���"� 'n dP���- 17G�J C—S <br /> � <br /> cr / - 5 c�:�T��y — <br /> NOTE WIRING IN NON-DWELLINGS IS F�EQUIRED TO FEE I <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAI SALES TAX CODE IS 3105 <br /> 1 hereby ce�iily that I have read and examined this application and know the same to 6e true and <br /> correct. All provisions u/la�rs and ordinances governmg this rype o(work will be complefeU <br /> whether speci6ed herein or noL The granting of a permd does not presurne fo c�ive authonty to <br /> violate or cancel lha provisions olany ofher sfate orlocal law rec�ulafing construction or the <br /> performance o(consVucfwn. That I am authonzed by fhe owner oI this property to pe�fonn the <br /> work lor v%hich applica(ion is made and I cumply with fhe Sfate Contracfors Law 18.27 RCW and <br /> 296200 IVAC. <br /> / � / <br /> � <br /> C.�\ ._(� �� �1� "'L-� :� � � �' � � p�G'3 -G � � <br /> E; <br /> %�Signalure ! j Dale ��" <br /> i r <br />