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( <br /> � - <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org <br /> l0 - i3-10 <br /> iAPPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ��O�D "a ' ! <br /> � 13z1 \\Z"�`' ;� S �� <br /> I PROJECT ADDRESS <br /> `I��t; u� C�r• �1 '� �2cx�*`—Sfi�6��1�1.� — <br /> �Wncr Ma�lAtltlress Cily SIa1M2ip P�ane <br /> CQIQ.�I.I C ��(�..� 132-1 ��21�-S�SE ��r�re.li' — � <br /> I Tenanl Ma�l AAdress Gly SlaleiLp Phone <br /> I <br /> � ,�.,a,��-, �». ��� z� ��. u�,n�- �a� �,� <br /> Gleclncal Conirnctor Mad AAAress City Slale�Zip Phone <br /> ��e.���u��\ ���2��Lqqs��. 2��« — <br /> S�e Lcense Number b�— Contract Pnce of Work <br /> ' �'�"lo.1 � <br /> ProposM Use 01 puddu�9 Contac�Person (Plan Rov�aw) <br /> Descr�ption ol Work lo Bc[kmc `�51 �_�y �Q,1 Y���� ._ <br /> NOTE: WIRING IN NON-DWELLINGS IS REOUIRED TO FEE <br /> BE IN RACEWAVS. MC OR�C CABLE. <br /> CITY OF EVERETT LOCAL SALES TAl(CODE IS J705 � <br /> I hereGy ceridy Ihat I have marl and exarnmed fhis applrcaGon and tinow Ihe sarne fo be hue and <br /> conecf All provisions nllaws anAo�d�nances govr�nmg fhis fype ul work wdl be complefed <br /> wheNier spea/ed herem o�nof The granlmg ol a permd does nol presume fo 9rve eu(honty fo <br /> violafe a cBncel thr.{�rovrsrons ol any ofher s(afe or local law re�ulehng conshuCtion or Ihe <br /> peAormance ol consfrucfron Thaf I am au(honmd by the owner of fh�s prnperty fo peAorm fhe I ! <br /> wvrk lor wlrrth ap��lrcahon rs rtrnAe end 1 cornply wdh fhe Stafe Conhacfors Law f B 27 RCW and j <br /> 746:00 WAC. . " <br /> � i , <br /> SlC � �� ' U <br /> tiignaWre Uaic <br />