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ELECTRICAL PCRM{T APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET. EVERETT, WA 98201 c� `b�O� <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org � <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �� ����� <br /> i <br /> ���=1%`C� 1 ' ' Ijb� �� `,• l : - i� `i i�; �% + � , � ?� <br /> PROJECT ADDRESS <br /> ,�,., , ; � , �� � �.: ��;1 f <n, :�r,, /i,� l�,�i1 � r� ���- r'�'.,,.� � <br /> Ownef A1ail Addiess Cily State!Zip Phone <br /> Tenani Mail Address Cily S�a�elZip Phone <br /> r - �.�tl. �r/ t'�� ri ��f: Lr`�/ i�e'�Z �t"�r7/iU !(::� iL�l'_ cJ`r,�Z?i ��_'.5���;i...i�'�i?' <br /> [lectrical Contractor Pdail Address City S�ate2ip Phone <br /> � �� :V((i[��-k' �-�li-/ISI' -���C1 . 0 C1 <br /> Stale License Number Conlract Price of Work <br /> < <br /> > iS�-���1C� � -,� �� � I .� �i <br /> Proposed Use oF 6uildinc� Contact Persen (Plan Re:iev+) <br /> Descriplion ot Work to Be Done: � `'L.� /� `+� ���L1��'�`��1 � �����`� `' <br /> NOTE: WIRIfJG IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR�C CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certily tha(1 have read and examined fhis appGaation and know the same fo Ge true and <br /> correct. All provisions o/laws and adinances c�overnmg(his t}�pe ol u�ork tvill be completed <br /> rehelber spec�lied herein or noL The granting ol a pennd does not reswne to give aufhonty to <br /> violate or cancel the provisions olany other s�ate or local law reguPting construcGon or the <br /> pedormance o(construction. Thaf 1 arn authorized by(he oa�ner o(this property to peAorrn the <br /> work lor which applica(iorr is made and I comply wifh the Sta(e Contrac(ors Law 18.27 RCW and <br /> I 29G.200 WAC. - <br /> j �-� r _ :� - <br /> „ - <br /> —��-�,a'��' �' J -(�� '7 'L L- '� ' C'' <br /> �',l� SiynaWre Da�n I <br /> �US"Q�'G��.`- � <br /> I�__._.._ . . . . _... __..__._...___. . . _____ _. ._ ..... _.. . . _. _______—__ __ <br />