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� � <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857-www.evereriwa.org a `'a� `�� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM C��a—1�l <br /> 1 �Z� �P EV'e,�'LI f'�e� � <br /> PROJECT ADDRESS <br /> //� /�' /�u` ,21' ,�G� .�fj- Lv�e�B'�oz/ <br /> (�wner Mall Address Ciq� Sfate2ip Phone <br /> �GtF1C�lo �YCIVII.�� <br /> /�-.-� �d-' i�s�'�L� <br /> Tenant Mail Addresg Ciry Statel7Jp Phone <br /> (�d� 7G%8tG y <br /> Cf,clC/L=rU7' [`LL(' i2(� 7��/ S /�cN�(�ti15i, S�A 1,�998lD$_ <br /> ElectricalContractor Ma1lAddress Clty SWte21p Phone <br /> C�'�"I� � '� 9 5 b �i �.� S l�J D "=-- <br /> State License Number Contract Pdce of Work <br /> Proposed Use of duilding Contact Person (Plan Revfew) <br /> Description of Work to Be Done: I' � ��-� L R- � �= �'� 2 CO t�l P 2 L�s d h F � �E �� �' <br /> A ti D 2 �:• 1;'A P �_ ,� N S '��'�,ARQc.�'� C / �C iJ I 7 S ,� O rJ��T_ <br /> ��l)2 (,U � L. l< ( lvG �,� ��Z�G�� <br /> � <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO �E <br /> BE IN RACEWAYS, MC OR AC �ABLE. �� 5 O <br /> � <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> 1 hereby certi(y that 1 have read and examined this application and know the same to be true end ��Z QZ — � l <br /> correcf. All provlslons of laws and ordlnances goveming fhis rype nf work will be completed <br /> whether specifled hereln or not. The grenting o(a permit does notpresume to g7ve aufhorily to <br /> vlolate or cancel fhe provfslons o(eny other state orlocal law regulaGng constructlon or the <br /> per/ormance of constructlon. That 1 am authorized by fhe owner of fhls property to perform the <br /> work Ior whlch applicaflon!s made and 1 comply with the State Conhactors Law 18.27 RCW and <br /> 296.200 WAC. <br /> �. ��-�.�'��.� - /S� �-- / Z <br /> Slgnature Date <br />