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( <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, E�ERETf, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> �0 �7 a t ve�r �tc��� �u� S <br /> PROJECT ADDRESS ' <br /> _(�ev �,�� I'a r S C�ii 5 ���.�- � � �' ��a J � <br /> Owner Mail Address City State/Zip Phone <br /> � �_� o���Sn� v1 <br /> Tenant Mail Address City Slale/Zip �� ,f� �C vph�o�n%2 � <br /> 5� ,.� �k ���,r{-�<< �z�i� I> � ���"A��� l�� ��r'r.i�,��� �.��, �o�y _ <br /> Electncal Contractor Mail Address City Sbte2ip Ph�ne <br /> � v��i�"C � �g ��o ��j/���; � o0 <br /> State License Number Contra i Price of Work <br /> �_�i r, ��c� v� �L o � <br /> Proposed Use of Building Contact Person (Plan Review) <br /> Description of Work to Be Done: � � l�� Ll !��� �� � G ��'� { � �J G `" ` > 21 V O \� <br /> f� <br /> l\r ^ C1 t^-� �'�Ce � 2 Q� '�� lJ f�.. f <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> B� IN f',ACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> 1 hereby certi/y that/have read and examined this application and knuw the same to be true and <br /> correct. All provisions of/aws ano ordinances govermng this type ol work will be comp/eted <br /> whether specdied herein or not. The granting o/a permd dces not presume to give authonty to <br /> vio/afe or cancel the provisions of any other state or local law regulating consVuction or the <br /> performance of construchon. That 1 am authorized by the nwner o(th�s property to peAorm the <br /> work lor which application is made and I comply with fhe State Contracto�s Law 18.27 RCW and <br /> 296.200 WAC. <br /> � � <br /> // �J�/ u � C �/ <br /> � <br /> Sign oi Date <br /> .ED�f�P �D¢ 3 <br />