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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT P'ERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />1�05 5i= C-verefi+ r-�lafl w�y <br />PROJECT ADDRESS <br />Owner <br />Tenant <br />Mail Address <br />Mail Address <br />Lli-�"�.C, ir1Pc � ��� <br />City State2ip <br />.S�i-t--{-i� �.1�4 qi <br />City State/Zp <br />% -�. � /O <br />Eia6�-115 <br />SIo I <br />Phane <br />aob>lo I <br />Phone <br />r�:c h�lech�„��1 Ro��3c�C �hyn ' Re�;woa�l w� ��o �I.�,r 8�� 3 <br />Electrical Conlrector Mail Address Ciry StatelZip Phone <br />`��GME5�143 t�� <br />State License Number <br />I����f-cu�� Sl�c'�Gc <br />Proposed Use of Building <br />�I� �80 `0 U <br />Contract Price of Work <br />G e�4-i` v�ei, ��et,�ab <br />Contact Person (Ptan Review) <br />1 e / nI' - <br />Description of Work to Be Done: e-�J�GI CQ. (,\ Q'DO�T+�C�i��LRat� I�li1.�'�' 1�-� 6�L l�l �L <br />NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO <br />BE IN RACEWAYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />l hereby certily that I have read and examined this application and know the same to be frue and <br />correct. All provisions ol laws and ordinances goveming fhis rype ol work will be complefed <br />whefher specified herein or noG The granting o/a permrt does not presume to give authority to <br />violate or cancel the provisions oI any other state or local law regulating construchon or the <br />perlo�mance olconstructwn. Tha! I am authorized by the owner o( fh�s propeRy to pedorm the <br />work lor which application is made and I comply wi(h the State Con(rectors Law 78.27 RCIM1' and <br />296.200 WAC. <br />i • � <br />FEE <br />Do�_ � !S <br />/ <br />