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ELECTRICAL PERMIT /APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREFT, EVERETT, Wr� 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTEO FROM 8 AM TO 4 PM <br /> 1� :/ % j l� i. '' I /Cr 1," <br /> PROJECT ADDRESS <br /> � <br /> `��;r�„� �c��,���n; <c , ,,>� , k'r7�,��; ���i/�� vJ� ��r-�6s� � l�',;�� , <br /> Owner hlail Address City StatelZip Phone ' <br /> Tenanl �1ail Address City S!ate2ip Phone <br /> �c tii��R> �� � rn�� I�l� ���F 1 b'22 /�-��nrs ui//c �U/�� ���?c`-C,�z s/�TC� ..�3 y� <br /> EleclfiCal Contrac�or htail Address City Stale/Zip Phone <br /> �N�r���� GG�/ �3/3 <br /> Stale License Number Contract Price o(Work <br /> � 1= () <br /> Proposad Use o(Building Conlact Psrson (Plan Review) <br /> Descriplion of Work to [3e Done: � �� /� M1-�� � �(_ ( �l�C <br />� NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CAF3LE. <br /> I CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereb}�cerfily fhaf I liave read and exarriined this application and kno�s:iie sarne fo Ge Gue and <br /> correcL All provisions o/laws and ordinances gorernmg fhis type ol woG �•-ill be completed <br /> �ti�hefher specified herein or noL The granfinc�o/a pernut does not resu•ne to gi��e aufhority to <br /> violafe o�cancel the provisions o/any other state or local la�v reguPfing construction or the <br /> performance o(construction. That I am aufhorized by the owner o/this property to pedorm the <br /> uork!or�vhich applica(ion is made and 1 conrpl�uith the State Centracte�s Laiv 18.27 RCL1�and <br /> 296.200 WAC, � <br /> � �___ 7i <br /> / , ..�.– ; : � / � <br /> / �—' G' � �� � <br /> ✓'� ��� � ���� •� <br /> ' Si�nalure Date ' <br /> �d�'(�- -G7c1 <br />