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( <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 42�257-8810 - FAX425-257-8857—www.everetiwa.org <br /> APPLICAT�ONS ARE ACCBPTED FROM 81UA 70 4 PM <br /> f Do b�i 12�'� l��S� �,v.��� 1���� � ��j � l��o <br /> PRaecr�wo�ss s , U"f <br /> g� . � � y l � �'� � <br /> OWner <br /> M�t Mdrce Cily State2p Phone <br /> �j/ D '�I� - <br /> Tenant . ���'� �� �p <br /> Pr��!si�n �:�ffG{�� �..�� �21��jd1r�l�ll�S� ��lMG(�W (�l� ��LZ <br /> Electrical Contractor MailAddress Ciry SfafdZiP Plwne <br /> Pr��i�ly��Ls 20�, �� <br /> SFste Lfomsa Number Contr-ad Price Of Wak <br /> �(,�S /G. m /�fi�e�� r� w � r� <br /> roposed U f Building Contad Person (Pla eview) <br /> �aiptlon of Work to Be Done' ,_,�/'L ���� <br /> ! <br /> NOTE: WIP.ING IN NON-DWELLING5 iS REQUIREU TO �E � <br /> BE IN RACEWAYS.MC OR AC CABLE. �D <br /> � <br /> Ct1Y pF EVERETT LOCAL SALES TAX COOE 7S 5105 <br /> 1 hereby cerbfy U�at!have read and eramined tl�Ts appliCatlon ond know the same to be true and <br /> aurec[ All pmvisions of laws n�d o+dinancss govenung this type opt work wilf be tompleted L I Z(,j�— (J�3 <br /> vi�etoBor can�e�he�pv/sons o/any�her state orl�law�e9uladng caisru�on or the� <br /> pe�lormence ol consvucltm. 7nat I am authorize0 by the rnmer of fhis pmPmtY�o perlorm the <br /> walt fw which appl�cetion s made and I corrlply wfth the State ConhacYors Law 18.27 RCW and <br /> 286. WAC. <br /> 2 Il� /� <br /> Slgnulu Date <br />