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ELECTRICAL PERMIT APPLICAT'ION <br /> CITY OF EVERETT PERMI'T SERVICES <br /> 3200 CEDAR STREET, EVERETr, WA 98201 � —�� � <br /> 425-257-SR10 - FAX 425-257-8857 —www.everettwa.urg <br /> APPLICATIONS ARE ACCEPTED FROM S AM TO 4 PM <br /> �'o9a�-�yv <br /> �� �17 �vcrc���N �n Lr <br /> PROJECT ADDRESS <br /> Ownef Mail Address Ciry State/Zip Phone <br /> J��� .5(. �,2C�YLS - S/•�11�i��o�� r-. <br /> TCnent Mail Address Ci y State/Zip Phone <br /> I�U, `���� � ��c�:t�i��- yr� r7�1�- �, � . �3A <br /> Eleclrical Conlraclor Mail Address Ciry State/Zip Phone <br /> /�Dv��v��ra3pr ��5-� <br /> Stale License Number Contract Price o(Work <br /> ��f�'!L Jc�-f �D�15 <br /> ^ ss�� sIGN <br /> Proposed Use of Buildinc� Contacl Person (Plan Review) <br /> n� � I �2 $ — <br /> ocscrip�ion ot work to Be Donc: �C ! �/"� �— I`���NC' � G� �/ 8/- q y// <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> � <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby cerfify fhat 1 have read and examined fhis application and know the same to be true and <br /> co�rect All provisions ofla�ti�s and ordinances c�oveminc�(Nis type oI work will be wmplefed <br /> whether specilied herein or not The granting of a pernut does nof resume to give au(hority lo � <br /> viola(e or cancel the provisions of any other sfate or local la;v reguPling construction or the J, <br /> performance o(consfruclion. That 1 am au(horized by fhe oa�ner o/Ihis property fo perform Ihe l,�� <br /> work Ior�vhich applica(ion is made and 1 canpty with fhe Stale Confractors La�v 18.27 RCW and � / <br /> 296.200 LNA , ,'I]�' <br /> �IV <br /> �z�/�� <br /> Signat•, . Uate <br /> i <br />