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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 � - a b-O5 <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org �09� g`�� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> ���� �� ��.��. 5� I 1 � Z� � <br /> PROJECT ADDRESS <br /> � i� A �'''L,5 �---s- � <br /> .Z.�_ � <br /> � <br /> Ov:ner t:failAddress City Slatel2ip Phone <br /> (� S L" �1f��H- � +` t���! - <br /> Ter,ant Mail Address Clty StatelZip Phone <br /> :;(>�-�� inl '`: �t���1�71 � <br /> EleClriCal CoNr�ClOr 61ai1 Address Cdy / � Slate2ip Phone <br /> t, ( .. �1 �`/✓� �7 <br /> I�l <br /> �'�, (1�� L�1 I �.`� �Z \% "'� �' <br /> State License Number Conlracl Pnce of Work <br /> Propo d Use o�Buildin� �- CoMacl Person (Plan Review) <br /> ,^�.� �N <br /> Oescription of Work lo Be Done: _ �% �� ���1 1_ �T�� 1�r��.'�11C��'� I <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 �n <br /> 1 herebo certily that I have read and examined fhis applicntion and Ano�v fhe same fo be true and �D v � (2"� <br /> conecC AR piovisions o!laws and ordinances 9ovenung th�s:ype o/wo�k�vill he complefed <br /> �.hethcr specilied herein or nol. The granfing o/a pernut doe� nof resume fo giva aufhonty t�^ <br /> violafe or cancel the�rovisions olany olher sfa(e or local law raguPbng conslruc6on or the <br /> pedormance el cansfrucfion That 1 am autho�ized by fhe o�vne�o/fhis property to pe�funn fhe <br /> work lor�vhich applic�n is made and 1 cornply�rifh the Sfafe G�ntraclors Law 18.27 RCW and <br /> 296.200 WAC. � <br /> �--- / <br /> � � Z G� �� �i <br /> Siqnaturc Date � <br /> i . . .. - - -_. . _ _ ._. _. . --...------------- <br />