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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, +�VERETT, WA 98201 a -o� -�3 <br /> 425-257-8810 - FAX 425-257-8857 -www.everettwa.org <br /> �/30�-A'� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> /90� ,�E� n- ,ovE.vv� <br /> PROJECT ADDRESS <br /> /907 ��r,�rr�Assoc�a� PoaoxzzL�c, S���E �,Ua9�12Z �zs•3s4•c�o�q- <br /> Owner Mail Address CAy StatelZip Phone <br /> TNu,��1 d R1� N�'uy�� l9U? I�E.�J� TT A ' ��EiLETf' tJ� q8201 Za.•383�it'So <br /> Tenant MailAddress City StalelZip Phone <br /> APot.t.v tifro 9gOo �q����'��e MuKw�o �� �275 yts3V4-Sa(y <br /> EleCtricalCon�rador MailAddress City StalelZip Phone <br /> ApOl.�nl�-O4�1- � � �/oo. o� <br /> State License Number Contract Price of Work <br /> G�Q�o� S��S /�RnzJeK �20�� <br /> Proposed Use of Building Contact Person (Plan Review) <br /> Square Foot g��sidential new conslruclion,remodel or addition) <br /> Description of Work to Be Done: N�+a� �%i J%UN i"� '"'""�� A�r <br /> NOTF: WIRING IN NON-DWELLINGS IS RE�UIRED TO FEE �(r <br /> BE IN RACEWAYS, MC OR AC CABLE. 'H IJ—��� C-� <br /> i <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 beieby certily fhaf 1 have read and examined this applicafion and know the same to be frue and <br /> correcL All provisions o/laws nnd ordmances goveming flus type ol work wi/l be complefed <br /> whether specified herein or noL The grnnfing o/a pennd does not resume to give authonty(o �j ( �J�',�. — U��S <br /> violate or cancel fhe prowsions o/any othor stale or local Inw reguPnting construction or fhe <br /> perfomiance o/consrn�ction. That I am nidhonzed by the owner ol this property to pedonn fhe <br /> work lor which appli tion is made and I comply with fhe Stafe Contracfors Law 1827 RCW and <br /> 296.200 WAC. <br /> /-l/-i3 <br /> SigneWre Dale <br />