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ELECTRICA� PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FR��M 8 AM TO 4 PM <br /> ��� �r,/�c r1�r.� , L�✓�.r-cT�,<,,�-4- <br /> PROJECT ADDRESS <br /> n �.-�y� ytsLS`96vy� <br /> SL,��•�4-�,(e /�.( �' � c. .2 '�� Ce/1,�, /9vc S7� i2� l.,•a- 982ot _ <br /> Owner Mail Address City State/Zip Phone <br /> (�om.n�n.TJc f��t/��i G9(ti 4 LS 25� G`14 6 <br /> �c,(a s /' � r i.i.,_ � /��/ N �'�+�n., S 7�$� 'rG�xna� � rf- �'1 82 0 / <br /> Tenanl MailAddress Ciry State2ip Phone <br /> 5�5,.,• �¢Ssxo�es��te (�,�y.� /��-''/}✓cNf_ S�z'� [.+.�4- ��S�Z <br /> Eledrical Conlreclor Mail Addmss Ciry Slale/Zip Phone <br /> . I C���T ��� B K�Q •� <br /> �� 'l <br /> State Licenso Number Contract Price of Work <br /> �'/r£o1��1 �/I�I�.J <br /> Proposed Use of�uilding Contact Person (Plan Review) <br /> Descriplion of Work to 6o Done: �� �eG�"'�C G✓� �/r-jvl S <br /> 0 <br /> NOT[: WIRING IN NON-DW[LLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 � <br /> 1 hereby cortifylf�at I ha�•�read and examined this ap/�lication and kno�v fhe same fo be true and �� 'U U��— ��5 <br /> correcL All provisions oi la�vs and ordinances govenung this fype of u�ork will be complefed <br /> n�hefher specilied herein or noL The granfing ol a pernut does no(presume fo give authonly to <br /> vio/afr. urcance/fhe prcvisionso/anyolhersfaleorlocallaw�egu/afingconsfrucfionorthe <br /> pedomiance o/ccnslr�n lion. That 1 am aufhorized by fhe o�rner o!th�s property fo perlomi fho <br /> work lor�rhich applicafion is made and I compty wilh Oie Stato Contractors Law 18.27 RCW and <br /> 296.200 V✓AC. <br /> �� C /�U�� <br /> i% <br /> �' Sign�ture Date <br />