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ELECTRICAL P�ERMIT AP�'LIGATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857-www.everettwa.org / a --O%-�Z <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM L''� Z� Z"D�� <br /> � � t 't':`rc�� L>A6 <br /> PROJECT ADDR SS <br /> Owner MailAddress Ciry State/Zip Phone <br /> � I I �ot�-�i�� -�7ys <br /> Tenant MailAddress Ciry State/Z�p Phone <br /> $L�tc C �53 <br /> � i,,o� E rr�;,, sf- ��4�fi ,� ��+ 9s37d- �v�7 -s��a3 <br /> �'�t' �25� �tc� � � � N( J-n <br /> Electrical Conlractor Mail Address Cdy Slate/Zip ..�-Dn-� Phone <br /> - I I" <br /> � () -Z �� tj�i� ��(JUr(JU <br /> S�ate License Numbe� Conlract Price of Work <br /> TJIQi� p CSt�F�— <br /> Proposed Use of Building Contact Person (Plan Revie�•�) <br />- Square Foofage(If residential new conslruclion, remodel or addilion) <br /> Description of Work to Be Done: � �'�- V � ' � r � �� <br /> NOTE: WIRING IN NON-DWELIINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, NiC OR AC CABLE. �i-� <br /> U � <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceRify that I/iave read and examined lhis applicalion andlcnow the same lo Ge true and e �� i ��O� ( <br /> correcL A/l provisions of laws and ordinances governing this type o/work�vill be completed L � <br /> whefherspecified he�ein ornof. The granting of a pennd does not resume lo give authonty to <br /> violale or cancel the prov�sions of any othersfate orlocai la�v reguPting const�uction or(he <br /> peiformance o/construct�nn. That 1 am aufhonzed Gy fhe o�mero/this propeAy to peAomt the <br /> �•�orR(or which applicafron is made and I comply wi(h the Stafe Contractors Lav� 18.27 RCW and <br /> 296.200 WAC. <br /> ' ' ' �:� a1� / <br /> l/� ��r�;x,- ' � � l �— <br /> Siqnature Date <br />