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�oiosiia ia:�� rnx <br />E:L�ECTRi(:AL PERMIT APPLICATIO�V <br />CITY OF EI:VERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8657 — www.everettwa.org <br />APPLICATIC:�NS ARE ACCEPTED FROM 8 AM TO 4 PM <br />��� s�,� ra,�rP.ik� r_„�r�#.� QB�o� <br />PROJECT ADDRESS <br />l�hi_m ���nl[J �'; <br />oW�e� <br />l.anirrn. �n�L '�; <br />Tonant <br />.�V� � <br />Mail Address <br />Mall Address <br />Cily <br />Clty <br />State2lp <br />f�ooi <br />-�ll <br />Phone <br />Phone <br />Cr7mm��nirnti�, ,;�n�.S.ui�,va�ln��,#ID6 �rlmmrl �,�a �i805� �a�R-a3�� <br />ElectricalContractor MnllAddross Ciry State2lp Phone <br />�c,�� I�nliq�3a1�_„�Inrl��Cl�l ::�C��n� SEQVIGI4�IIvK..S `� 13�'�Ss��; _ <br />Slale Llcenso Number CoMracl Price of Work <br />,,/+ t <br />. �ir�l r o�� l C 'r�4'�7-l� <br />Proposed se of Building , � <br />`��hra�l� ��rICPInn('I <br />Cont�ct Person (Plan Review) <br />Description of Work to Be � me: ] Y1�,}�11 I(� � i�3 �wi �[��� �O(7'e ry�S ��la ��%C1C�L _ Q f1C� <br />�Q.-in5��11 (1.0�_1,�.,1nSt�i11 no.�� IP G�f.mm��ni�0.-%"I('/1.5 (`�i,��L. <br />��c,� �Ib\�-;r{,;� <br />, <br />NOTE: WIRING IN NOf! •{)WELLINGS IS Rt:QUIRED TO <br />BE IN RACEWF";i, MC OR AC CAE!LE. <br />CITY OF EVERETT LOCAL :iALES TAX CODE IS 3105 <br />1 horeby cartily that I havo ��a d and examined thie: appllca(ion and know the same to be true and <br />conect. All provisions o(Ic ��5 and ordlnances goveming this type of work wi116e completed <br />whether speci(ed herein o.� �nt The granfing ol a permd does not presume to;lve auB�onty to <br />violate or cancel the provis�� �ns of any ofher stafe orlocallaw regulating conshuctlon or Iho <br />pe�lormance o(constructioa That l am aufhonzo:iGyQ�e owr.ere/lhis p�operty to perform ih.e <br />work for whfch appllcat/on : caade and / comply v, ith the State Cor.t2r.lors Law 18.27 RCW and <br />296.200 LNAC. <br />� <br />h� ti Q -`�� .L .c. ' ID-nti-�n <br />SlgnaNro Datc <br />FEE <br />j�� p�o-025 <br />