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�LE�TRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERIVIIT SERVICES <br /> 8200 CEDAR STREET, EV�RETT, WA 98201 �—�D���j <br /> 425-257-88?0 - FAX 425-257-8857 —www.everettwa.org c��o �_�66 <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 0. PM <br /> �'1���'� ��� � ��� �� ��l I I:C�r�� <br /> i r�OJECT ADDRESS <br /> � ���oL� � � �1�� ,� `�� ? - r � �-�y'f !�i` <br /> Owner Mail Address ���Y <br /> StatelZip Phone <br /> � °i d���l <br /> lnu�y tc�r�� Or S� L �o. .{r 11.; -�- �i;�S" � '�3";�3°��) <br /> Cil StatelZip Phone <br /> Tenanl Mail Address Y <br /> � � „ ��� � d r ,� �� , � z�a -�I �� ��L �l� �< <�'a � ��.555 <br /> { S�ale Zip Phone <br /> Elect�ical Conlractor Mail Address City � <br /> _� l ,�(Y7 <br /> ��"�"v�<<� �U�a���G�"�l ` � � �� Contract Pnce o(Work <br /> Slale License Number <br /> n �u5tu �.�5�3N5=G;�,3 � <br /> � ' � •`�'' ��r' Conlact Person (Plan Review) <br /> Proposed Use af Ouildiny <br /> ISquare Footage Qf residenlial new construction,remodel or addi�ion) <br /> � I „ �';���E l,U� �t r�e.�� � <br /> IDescription of l�'ork to Be Done: ���"��e c{ ^I V �� k°�� <br /> I <br /> 1 <br /> I <br /> . FEE <br /> NOTE: WIR;NG IN NON-DWELLINGS IS REQUIRED TO � �u <br /> BF �� RA�,E'NAYS, MC OR AC CABIE. �7 ___ <br /> I� « � <br /> ' I CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> � 1 hereby ceitify!h�:f 1 have read and examined lhis application and kno�v fhe same fo�e We and �12/� ( � I/„ r, <br /> correct. All provisions of Imvs and ordinances goveminr�lhis type of wo�k will De,com /efed l JlJ I �� �c� <br /> �� II v olafe orPan el�l�e prov�ions o/ar y ofhei�stafe�or�oc�l doesc�t�p�e��consfr2l cfion or tl e�y�� <br /> i <br /> i per/omiance ol constiuchon. That I am aulhonzed byl�ie o�vnerolfhis property lo pedorm Ihe <br /> �i ��;ork(or which application�s made and 1 wmply�vith the State Contractors Lm�✓ 18.27 RCW and <br /> 296.200 WAC. <br /> � � /� • <br /> � --�"� ����� �i "7'✓l�,---- l-3�- � �3 <br /> ' Signature � Date <br /> I <br /> I -------------�---._.—_ . . .. ___ . _ __ _.__ . _. ..- - --.__� <br />