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ELECTRIGAL PERMIT APPLlCATION <br /> �,, CITY OF EVERETT PERMIT SERVICES <br /> ; 3200 CEDAR STR�ET, EVERtTT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857-www.everetiwa.org I� ` a�7 `�2 <br /> Gsiaia--Ooa- <br /> �PPLICATIONS ARE ACCEP?ED FROM 8 AM TO 4 PM <br /> 1 � � � , , - - , <br /> (:�� ��/ t`� ��'C!'l ;C.l�. �y,;� , :� ," �'- .' !,;�, <br /> .. <br /> PROJECTADDRESS <br /> ; I 1 I�� 117 �vzr,�r����� ���'�>> �� ��{z7� v�� �g ���i <br /> Cwn2r MailAddress City Stale2ip Phone <br /> �/ � � � '-i � � � � �2��� rL.L���, �'�(t� ��Lf?il f W�� �� ✓ � � <br /> Tenanl MailAddress City State/Zip Phone <br /> y/� M � , , , . ,� z /� �'7 ('� ,g� 7 �, � zgl � � , <br /> jJ�l��k�L L ��11� �i���r;,n^� � '1 !v L 7 �1e ��PI,✓`! �'I ����^L �' �� `� �/ 1 �IC7 ) " <br /> ElectricalConlraclor MailAddress City StalelZip Phone <br /> P�;��� ��� ��►�.� G <br /> �)��- 2'Q • �7� � <br /> Slate License Number Contracl Price of Work <br /> �L� q ���_� I/ � ':1 ) �+' ,, <br /> �e�� a�� �?l��(�- — � <br /> Proposed Use of Building Conlact Person (Plan RevievQ <br /> Square Foolage Qf residemial new c„nstruction, remodel or addifion) <br /> Descrip!ionofWorktoBeDone: -Lr'_�-����\ 7�� `,�C��[�' �" v'"'�'��'"��/ <br /> NOTF.: WIRING IN NON-D`NELLINGS IS REQUIRED TO FEE �'Q �� <br /> BE IN RACEWAYS, MC OR AC C�BLE. t' <br /> l� <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> !hereoy certil�th?t 1 have read and ex�mined fhis application and 1<no�•�the same fo be true and <br /> conecf. A/l p�ov'sions of laws and ordinances govemmg,fhis(ype of�vork�:�ill be compieled <br /> �vh�(herspecified herein ornot. The grantmy o(a pen�u does r,otp resume to give authcnty to —UO Z <br /> viola(e or cancel(he provisions o(any othersfate orfocalla�v regula(inp cons(rucfion orthe � � Z � Z <br /> i performance of construction. That I em aulhonzed by lhe ownerof thisp roperfy to peAo:«i!he <br /> wodc(or�^+hich dpplication is stade and I c�mply v�ifh fhe State Contrac(ors Law 18.27 RCW and <br /> 296.200 WAC. <br /> . . , _ -� . � •i . <br /> � - � < _ <br /> ,..- <br /> %-__ --- �-- ---- ---- <br /> - Signature ����Q <br />