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ELECTRICAL PERMIT APPLICATION <br /> CI�'Y OF EV�RETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> 7/! <br /> /� ylq i� �lv� S�, � G��(���d7 <br /> PROJECT ADDRESS <br /> �v�2d.riv p�v F-'o�o� t�S1 sti�vho��isti �/r 9°aZ�rl yL,S33y,So/8 <br /> Owncr �dail Address City Slale2ip Phone <br /> K� D S f'C, ow�rdiS_ <br /> Tenant Mail Address Cily State/Zip Phone <br /> ��� SrRvi c�rL �����rz;�_ i��e, i�?,as %,zw �v� S'ti��h�,r�sh �i1>�yd z�� ZD63�%o�a l <br /> T <br /> Eleclrical Cor,tractor Mail Address City State/Zip Phone <br /> ,�-�� SErl /2��N 2yao `�`=— <br /> State License Number Contract Price of`Nork <br /> C�l�rr(C��S ��G� JO���}-/✓ <br /> Proposed Use oi�uilding Contacl Person (Plan Revieei) <br /> Description o(Work to Be Done. _ (�1J(2�— L��'Z�-/�3 FD� l� ��EF[�=� j � IZT(�uGs9-!� <br /> `l C5-r� 7�S <br /> I <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RAC[WAYS, MC OR AC CABLE. <br /> I CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> i <br /> 1 hereby certily that 1 have read and examined fhis ap�lication and know the same to be true and <br /> correct. All provisions ollaws and ordinances�o��enung fhis type ol work will be cornpleted <br /> whether spea6ed herefi or noL The g�anfing o(a pernuf does nof presume fo give aufhonty to <br /> violate or cancel the provisions ol any ofher sfate or local la�v regulating consfruction or the <br /> perlonnance olconstruchon. That I am authorized by Ihe owner ol tlus properfy fo pe�form fhe <br /> wor(<!or which applicatiori is made and 1 comply�vith fhe Stafe Confractor;Law 18.27 RCW and <br /> 296.200 WAC. <br /> �i. � � l .�� � —C ._Q� <br /> Iiignalure Date <br /> G,C��,- 7'�, <br />