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r , � <br /> ELE�TRICAL PERMIT APPLICATION <br /> CITY Q;' .VERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, �VA 98201 <br /> 425-257-8810 - FAX 425-257-8857—www,evereriwa.org <br /> APPLICATIONS AkE<`.CCEPTED FROM 8 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> Lj�{�i`� <br /> �`o �f�� lJ�. s� <br /> PROJECT ADDRESS <br /> � � ,�- .� L�C. � <br /> �-� �� �� ��� �io C'���� ��- 9�2.�� <br /> Owne� Mail Address City SWte2ip Phone <br /> Tenant Mail Address <br /> ��b State/Zip Phone <br /> �rc�rt�c;�. �``�f-� �`Z'�5' ��r��vocx�D /�Q i�'oiz 7� �70� <br /> Electrical Contractor il Address � ty State2lp Phone <br /> �LEc rG'G i�o�I�" ��3/��� �� o <br /> -7 a+CS <br /> � l� <br /> State License Number Cont ct Price of Work <br /> f v��, p S f.� <br /> Proposed Us of Buildmg Contact Person (Plan ReviPw) <br /> /,(/ /�/ / i <br /> Description of Work to Be Done: _`7 DU UG(T" �-�67 l�(� �/G??��'��U/G .� <br /> NOTE: WIRING IN NO�'-06'VELLINGS IS REQUIRED TO FEE <br /> I9E IN RACE!�VAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL,SAI_ES TAX CODE IS 3105 <br /> I hereby certi/y that I have reac'and examined this application and know the same to be true and <br /> correct. All provisions of/aws and ordinances govermng Lh�s type o(work will be completed <br /> whether specified harein or noL The yrenting of a permit does not presume to give a.!honty to <br /> vio/aIe or cancel fhe previsions of any other state or local law�egulating constn�ction or the <br /> perlormance ol constructi�n. That 1 am authonzed by the owner o(thrs property to per(orm the <br /> work which applicatior is made an�compty with the State Contractors Law 18.27 RCW and <br /> 296 0 WAC. <br /> � 2 �v���� /� � /y— � � <br /> SiynaNre Date <br /> I �c+{�G-oGa <br /> I <br />