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ELECTRICAL PERMIT APP�ICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 96201 -'� �a p—/(7 <br /> 425-257-8810 �AX425-257-8857—www.everetlwa.org C�O�.�vOp� <br /> o✓ <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> %��G/ /l'1Ci'n'?L� (/��i�ri� �A�/GvJAN ����1���1 <br /> PROJECT ADDRESS <br /> �'1 ��/� � 7 �/r %%�i''� �/' 'i�I'�' �J�� �'� � �'v �f������'�-I'I.�'�a.�.c'�i �%) .I%'��� `7 <br /> Owner Mail Address Cily State2ip Plione <br /> Tenant MailAddress 7/�ji2 City Slate/ZIp Phono <br /> . <br /> ; IU� ' jG� ��L �s��a.- <br /> 5t'n/5� �� ,.T,. , �, 'l /:.,�� �; ;c,c//�.v �co�/,',1/F,? � d' rJl _ <br /> ElectricalConlrector MailAddress City Slate2lp Phone <br /> .�.�:^✓ t f%..-'- �i C/ ? /;lL ��L'L' �_r <br /> Stale Lfcense Number Contract Price of Work <br /> , � , <br /> > >, /��-�c ��a�� ��.�, E,�-1��:��o <br /> �>//-i'�n��.��7-S <br /> Proposed Use ot Building Conlacl Person (Plan Review) <br /> /-�� �. , <br /> Descriplion o(Wark lo Bo Dono: lV'' U'LL-� /�'��'' ��r�� /"� �;7L'�'� <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEN'AYS, MC OR AC CABLE. <br /> CITY OF EVCRETT LOCAL SALES TAX CODE IS 3105 <br /> 1 heroby certily thut f have reod und exarnined fhis ap��licafion and kno�v fhe samo to be 6uo and <br /> coirect. All p(nvisions o(la�vs and ordinances�ovemmg fhis typo ol work will bo comploted <br /> whefher specified herein or noL The granting ol a pernuf does nofl�resumo to give authonty fo � <br /> violafe or cancel fhe provisions of any othersfate or local Inw re�u afing construchon or the � � <br /> perfomiance ol conslrucfion. That I am aufhorized by fhe owner of this pmperty(o peAomi fhe z <br /> work for uhich applicafion is made and 1 comply�vifh tho Sfate Confractors law 1A.27 RCW and '1 - �/ �� <br /> 29G.200 4VAC. � ' a1 <br /> ���m�� <br /> � � � , �� >_- Gt/�u�l� ���v ��' /� �l <br /> Sic�naWre � ' Dale <br /> ._��J�� ��j �"� <br /> �� <br />