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ELECTRICAL PERMIT APPL�CATION <br />CITY OF EVERETT PERM13 SER'ViCES <br />3200 CEDAR STREET, EVERETT. VJA 98:?01 <br />425-257-8810 - FPJ( 425-257-8857 — Hrww.everettwa.org <br />APPLICATIONS ARE ACCEpTED FROM17 8 AM TO 4 PM <br />� �� � y ' <br />_� �, .>f. �, <br />PROJECT ADDR[SS <br />_�'�� 'iJ.^. �C L" <br />Owner A4ail Address <br />, � <br />i , <br />V' --1�._i �'v�,1.� ">`> C� <br />l enanl Mail Address <br />L,_ � `,;= 7:{=;'c ( <br />-- City <br />,�� �F f:.,/.�_.. <br />��� . <br />�r,; Ll�� .��,,�,%� i�r7�7 �z-�l i,...�,�.��,� ,�� <br />Electrical C�on4acWr �taii nddreu r.itv <br />f�: �J �''— �. I f: L �7 �� � i7 '_ <br />Slale License Number <br />Proposed Use of Building <br />Stale/Zip <br />Stale/Zip <br />.,<: �✓i i83z <br />Statc'Zip <br />Phone <br />_,.� tL-/� %Y.�.-S' <br />Phone <br />zs; r.rz�s�3 <br />Pno�,� <br />/ i � cc"c , _ <br />Contracl Pricc o( Wurk <br />Contacl Perso� (Plan R�vicw) <br />Descrii�lion ol lVork lo Oc Donc: __� ��,-i' ' ���` �� � °�� i�� y`_ �. _ � � = _ iu �v <br />��. z�� � - i.. � �`' . �r �.r <<, �u �_ ��o�� ,�., �� � <br />— — <br />�>C �:r - v. ,e.� • �. _ <br />NOTE: WIRING IN NON-DW'ELLINGS IS REQUIRED TO <br />R� ;N RACE��l;YS, MC OR AC CABL[. <br />CITY OF E\�ERETT I.00AL SA! ES TAX CODE IS 3105 <br />I herebvi certily that 1 have read and ex�mined this application 2nd kncu� fhe same to be true and <br />correcl F11 provisions o//a�vs and wdii�ances governmg flus fype oI work will be complefed <br />whethcr s��ecdied hercin or nol. The c�rar.fin� ol a pernnt does nof presun�o to give authordy lo <br />violate o� cancel fhe /�rovisions oI an}� ofher state or local law reyulating construcfion or fh� <br />periomiar-,ce olconsiiucfion. That 1 arn aufho�izedGy fhe ouner oI this property ro pe�fomi tho <br />�ro�k lor �rhich applicafion is made and 1 con�ply wifh the Stafe Contractors l.aw 18.27 RCLh� and <br />296.200 IM1�AC. <br />..-�_. � �ir <br />/�:. r' V'. '� . <br />�i)- �' � -CJ <br />FEE <br />`� '(:���''�2�' <br />, C; <br />