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ELECTRICAL PERMIT APPLI�R �TION <br /> CITY OF EVERETT PERi1111T SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-Si310 - FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE kCCEPTED FROM 8 AM TO 4 PPA <br /> �DU,2� 13f� AVc W <br /> PROJECIADDRESS <br /> �-9�dLc Cc�uurm C'��,vst• I`�a�si„'/le `�/F �l�'azU Cs�� G53-iq .y <br /> Ovdnef �,1ail Address Ci�y SlatelZip Phone <br /> TenaN Mail Atldress City State/Zip Phone <br /> �r• e�YUR y �o��cT�� �O• ��o,� �S'2� �Ants��i lle� LVR• `7'%'27a �a�zc��Zd- �3�c> <br /> EleclfiCal CoNfaClor Mail Address City Stata2ip Phone <br /> C�Lr�rvc.•�EGCyl3� T J �� Q� <br /> Slate License Number Contract Price of Work � <br /> S�'1� I <br /> Proposed Use o(Building Contact Person (Plan Review) <br /> Description of Work to Be Done: I S� 7 �� F r� 4v� w ��S /, <br /> NOTE: WIRING IN NON-DWELLINGS IS RE�UIRED TO FEE <br /> BE IN R.ACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I he.reby certily fhat 1 have�ead and examined fhis application and knou�fhe same to be true and <br /> conr.c(. All piowsions olla�vs and ordinances governmg this type ol work tvill be complefed <br /> �vhelher specdied herein or not. The grantinc�ol a pernut does not resume fo give aufhority to <br /> violate or cancel the provisions ol any other sfafe or local law reguPting consfrucfion or the <br /> perlormance ol conshuc6on. Thaf 1 am authorized by the owner o!this property to perform fhr <br /> �voik lor which applrcation is r�ade and I comply�vifh the State ConVactors La�v 18.27 RCW and <br /> 296.200 WAC. <br /> � �i-".�� �2 —�-.�^��"`> !-- <br /> SignaNre Date /�_/'��— � � � <br /> (i jVG <br /> i . . .. _ . . . ... . . . _ ._. . _ _ _"_.__" '___.'_'__—_"_ <br />