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n <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 /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �Z'-�5`�� <br /> �t/c�� ��,M.. L.�p ! Z <br /> 6Uo0 ��''1 �"� �-Y? l,�/ G��;.� <br /> PROJECT ADDRESS <br /> � zS'377 yiv� <br /> , <br /> � ; �, <br /> �`�C�� i � Uc�.S�� l�} 1GtilrK« CUf'�{ � �-L�� �� �� Z�� <br /> Owner Mail Address City State2ip Phone <br /> r� , <br /> Tenanl Mail Address City Stale/Zip Phone <br /> , L/ zS� 23`! �'izZ <br /> � � • J �- i 7 � .� i r� <br /> ��', , �, ,ru I} u-.ur� r` l� �'d �° �- �� i���k 3 -r;�- /c,lG S �_�„7 /.c�i'i ia ts�� <br /> EleclriCal Contraclor Mail Addre,s Cily State2ip Phone <br /> � Z O�� � <br /> Stale License Number Contract Price of Work <br /> ��-f���i� <br /> Proposed Use of Buildiny Conlact Person (Plan Review) <br /> Description o(Work to 6e Done: I !I s,I.�l'/ / �F /� 1��� � ����� �S ��' ���D z`��`'�' ��'�� <br /> l 12c� '�'�'l� ��S �j%('t c�S l�'� ! ' !C-/�L�,c, <br /> NOTE: VJIRING IN NON-DWELLINGS IS RECIUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 �G��`z _��3 <br /> 1 hereby certily that 1 have read and examined this applicafion and f<no�v the same to be Vue and <br /> correct. All provisions olla�vs and ordinances goveming fhis fype ol svork will be complefei� <br /> whether spec�fied herein or noL The c�ranfing o/a pernut does not presume to give authordy to <br /> violafe ur cancel the provisions o(any other state or local law regu/ating wnstruchon or Ihe <br /> peAorrnance o(construction. That 1 am authoiized 6y fhe owner o/fhis property fo pedorm fhe <br /> work lor which applicafion is made and 1 comply wifh thc State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> <—� <br /> i <br /> .�� `.-�j� ,.��j.-�.'� �i.,. �� / � "�f.��C�/ <br /> —� Signalure / Dale <br /> ./ <br />