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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT 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 /> � <br /> /D ��? � �C='/ ' l�v� `%l" <br /> PROJECT ADDRESS <br /> IJZ�-.>> `1 -/6i/ <br /> � <br /> =;�;, �/�, �, ��;�:,�;,��� iCy�' 7 iCy���s'� f�n ���z oy <br /> � <br /> Ot'mef Mail Address City StalelZip Phone <br /> TenaM Pdail Addmss City SlatelZip Phone <br /> �;'/��s,%f� 5,/s 1� Sr�c:t� �'�C/ �ic���;4� �.« � �j5",� / yZ�=�S�f" ' �/ <br /> � <br /> EICCIfiC�l Cont�aClor Mail Address City StatelZip Phone <br /> cy� <br /> ����ti�ssiyz �� ��`—vu — _ <br /> State Lir.ense Number Contract Price of Work �/`}-_z 3�j_�7 6' <br /> �1` S /�/ L�/<1��� c� <br /> Proposed Use o( Building Conlacl Person (Plan Revic:�v) <br /> Descriplion of Work to Oe Done: /%�� /���./�� T /7 ' r (/`�"�/�� ��T / <br /> NOTG: WIRING IN NON-D`�/EI_LINGS IS REQUIRED TO FEE , <br /> BE IN RACEW,SYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 heroby certil}�fhat I have read and examined fhis applica6on and kno�r fhe same to be true and <br /> correcL All piavisions of la�vs and ordinances govemmq fhis type uI�vork will be cornplefed <br /> whethe�speci6ed herein or noL The grarrtint�o(a pernnt does not resume fo�ive aufhority to <br /> violate or cancel fhe provisinns o�any ofher stafe or/ocal law reguPfing construction or fhe <br /> per/ormance o(construc6or�. That 1 am au(horized by fhe owner o/fhis property fo pe�form fhe <br /> work Ior which app/icafion is made and 1 comply wifh the State Confraclors Law 18.27 RCW and <br /> 296200 WAC. <br /> r'� / -�t�— E, - �S"U9 � <br /> '�% l ` -z": -- �. � <br /> / Sic�nature Dale r i /�, <br /> �i U <br /> V <br />