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( � <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 �/D `�Z <br /> 425-257-8810 - FAX425-257-8857 —www.evereftwa.org �/�9_�(,�2 <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> � 31 O ��R iZ <br /> PROJECT ADDRESS <br /> �iz���zY Lvc�z�r� w�R 4�2� I <br /> 2s. Zs2. 28� <br /> �u�7�Eti3uT <br /> OWner MallAddroae Ciy Statarzip Phone <br /> S�P�E <br /> Tenant Mail Addrese Ciry Stete2lp Phona <br /> CZCFERRrDFI.eC-T�L �� Po �oX -i�►2o � �-�r�� q��77 q2s,5�3 391� b2 <br /> Eled�lcal CoN�acto� Mail Addreu CNy Slete2lp Phone <br /> /� �� J_ re <br /> � ' `r �L' J� " ��� Contract`P)of Work <br /> S ete Licenae Number <br /> �2 rc v.� C-�Z`f <br /> Proposed Use of Building Contecl Person (Plen Revlew) <br /> Squere Foolage(If resldentlel new conslructlon,remodel or eddition) <br /> Description oi Work to Oe Done: l_.o ro�t=�-T �1.�E l�— � O �m P R�s S�Z <br /> �� 1 �S P� CTl04J �� or�DP�'� <br /> NOTL-: WIRING IN NON•DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CO�E IS�106 <br /> 1 hereby ceRily fhet I have read end examined fhls applicatfon and know fho seme fo be true end �I n/'� � O� <br /> correct. All provislons ollews end ordinances goveming fhls(ype ol work will be complefed p�� I <br /> whefher specified heraln ornot. Thq grenling ol e permif does not resume to pive aufhanty to <br /> vlolafeo ancel�he ProvislonsolenyofhersfafeorlocallawreguPtingconsfrucflonorfhe <br /> peNorm n ol construcffon. Thaf I e^i eufhorized 6y fhe owner o/fhls property to perlorm fhe <br /> work/o wh h appllcafian!s made eno 1 comply wifh the Sfa�e Confraclors Law 18.27 RCW and <br /> 29 . W C. <br /> g - I � - I`�Z <br /> Slgnature Date <br />