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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425•257-8810 - FAX 425-257-8857 - wvwv.evereltwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />�,5� ��� �S . 5'ul � o-rr-G�, �-� <br />PROJECT ADDRESS <br />s�H� G�b`�tc,r,� �1 /S"� <br />a <br />Owner Mail Atldress <br />y1� 3y�'-SZGG <br />%7 � �u/ lrr/.��� Gu R _ <br />Cily <br />Slate'Zip <br />Phone <br />(�---ic ��t S�+'�'�" <br />Tenant Mail Address City Stal�:Zip P�one <br />��c S-� ,�.saz f�u�� �'c �v.p,�,� c:�4 4k2o i�r b�6-3x3 L <br />Eiectrical CoNraclor Mad Atldress Gty Stale2lp Phone <br />�RG E� �- �1'��G 6 <br />State License Num6er <br />/�.+5/ G� l� I�'4� �G [ �l L <br />Proposed Usc of [�wlding <br />Description ol Worh �o De Cane: <br />�u�`�r��rS <br />NGTE. 'A�IRWG IN NON-DWELLINGS IS REQUIRED TO <br />BE IN RACEWAYS, ��iC OR AC CABLE. <br />CI7Y OF EVERETT LOCAL SALES TAX CODE IS J105 <br />v� G. <br />/ ( �, S��d K_ <br />Contract Price of Work <br />i� �O�t <br />Contact Person (Plan Reviow) <br />' r�ereby cert�!v fhat I have �rad anr/ examined fh�s applrcafion and hncw the same �c be true and <br />, .:evrecL All piuv�sions ol laws and ord�nances govermng fh�s type ol work wdl be completed <br />'.vne�her spealieo neiein or noG 7he grant�n9 ul a permd does not iesume fo grve authenty tc <br />.,..lafe or cancel the prov�sions ol any ofhrr sfafe or local law reguPGng construcbon or Ihe <br />; pe�oimance ol construc6on. 7hat I am au(honzed by the owner ol this property fo perferm fhe <br />�, ��.v�rk lor whicA appOcafion is made and I c�mply wdh fhe Stafe Contracfors Law 18.27 RCW and <br />i 295.200 WAC. <br />� <br />`_.-�:;A ._ <br />= ,,�., � - <br />FEE <br />E d5 o2-i�9 C, <br />»> _ <br />_<�(,� <br />�, <br />