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d <br />ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 Gj � S_� � <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org �, ao9 -011 <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />�� U� C111� S1 S �J <br />PROJECT ADDRESS <br />� la ���-� : ..�,� l�l� l� <br />Owne� ldail Address <br />� G (� c.� Z�� 1 � <br />S�- .,� <br />Ciry <br />�� �, `� � I � � <br />SlatelZip Phona <br />Tenanl Ma�l Address Cily Slale2ip Phona <br />Z �, � � <br />\I/ �' � ' �Z��C) ) 1�- ' o ^ U� <br />V � �7 � � � � �� �- � • ` �l (v`a'' �' w � V a � �' � � � <br />[Iedrical Conlractor Mail Address CAy Slata�Zlp Phone <br />�SG�� �c <br />v �, � �. � e_.. � `� `'� � � �> . <br />Slaln License Number Con�racl Price of Work <br />ZC�c �U� LiV�2" <br />�h 4 <br />��,.���_,,, �. -�l� ,,._���� <br />Proposed Use of Building 1 Contact Person (Plan Review) <br />� -� L, �•J <br />Square Footage Q( residential new construction, remodel or addition) <br />_i__ �,.: 1\ ,�� �'..\� �.�.� 4i�� <br />Description ol Work lo �e Done: <br />� � �-�,1 � d �� F -1 i� �. �� s, <br />�t_�l� �r.�,1i`4'1re���� �,� �irn �- ' <br />�,c�.l� �.1iJ-,-, Ji�-ll ��.t�'�7���1', i�..l ��t�rl iC,�ieJ <br />NOTE WIRING IN NON-DWELLINGS IS R[QUIRED TO <br />I3C IN RAC[WAYS, MC OR AC CABLE. <br />����, �,{ ���a y�� y/� �!� <br />Z u �l� alz� 6� ;„S�.IC, <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br />I hemby certily thnt 1 hnve rend and ermnined Ihis np/�lication and kno�v fho sanro fu Ge 6uo anJ <br />coi�ecC All p�ovrsions ollaws anJ ordmances govemmg fhrs typo ol u�ork will bo comple(ed <br />whefhe� specilicJ heroin ornoL The gianfing ol a pernut does nol n�sumo fo �ivo aufhonty fo <br />viulate orcancel lhe vasisions ol any ofhersfato orlocnlla�v reguPfing consWcfion or lho <br />pe�(omiance ol coiis�ructiorr. 1�hat I nm auflionzeA 6y (he ovntor o/ fhrs /voperty fo pe�form tho <br />work lor which applicatian is rnado r�nd 1 cornply �vilh fhe S(a�fo Confrac(ors Lnw 18.27 RCW and <br />296200 WAC, * <br />/��� !/,� /�.i r � / l <br />1�����—� / — <br />� SignaWre Dato <br />'�(' . IY� C . <br />FEE <br />lo� <br />�IZoq-UI( <br />i <br />v,Z <br />