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ELECTRICAL PERMIT APPLICATION <br /> CiTY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, �VERETT, WA 9&20? ��__�J_�� <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org <br /> �o7li-d 65 <br /> APPLICATIONS ARE ACCEPl'ED FROM 8 AM TO 4 PM <br /> � � ���, � �,��,4 Vf S � 5%,c��, �—c i�� <br /> , <br /> PROJECT ADDRESS <br /> (7v�lCi>21�(v��' 7;i/ '�z�"3�N,5��� <br /> Owner A�fail Address Ciry StatelZip Phone <br /> /iL'Sfl+�rfaiL,� C�, <br /> Tenanl Mail Address City State/zip �'hone <br /> � �� sr-�ZVicrc �;'c��t /��'S" y�--u� c��y SUUhc�rsf, uyl 9'�'L�6 �'G 3C,�'o/o/ <br /> ElecUical Cont�aclor Mail Address � City State2ip Phone <br /> � � !�c: <br /> �<.�. SrZ C 'l i ZS�N _ � /Do -- <br /> State License Number Conlract Price o(Work <br /> � � �-( t��lz S t���+��C �l2l�i0�14/ <br /> Propoeed Use of Build!ng Conlacl Person (Plan Review) <br /> Description of Work lo Bs Done: �ti'S � �f � � / ti r>a'1�Giayc G��/,2<r-"� � ;��✓ Lc�-�9�� <br /> _S'� V�4.i,' L/G�/i �Cfr'u�c�T <br /> I NOTE: VJlRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> j BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY UF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certily that 1 have read and exarnined this application and kno�v the same to be true and <br /> correcf. All provisrons ollaws and o�dinances govemm�tlus type ol�vork will be complefed <br /> whefher specdied herein or noL The granting o/a pernut does not resmne fo give aufhority to <br /> violafe or cance/the provisions ol any ofher state or local law reguPtiny cons(rucfion or the <br /> perlormance ol consiruclion. That I am aufhorized by the avner allhis property to pedorm the <br /> work Ier which application is made and 1 cornply wilh the Slate Coniractors Law 1827 RCW and � <br /> 296.200 WAQ C <br /> �" � 1 ���� <br /> C�� ��'� � 3 c� � <br /> Signatur ate ^ 1 �� <br /> I/ � � <br /> V <br />