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ELECTRICAL 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 FROM 8 AM TO 4 PM <br />��=� � :.:'� �; ��, "t (�- �, % <br />PROJECT ADDRESS <br />`:: �u,�T-I'i3 ! - <br />Owner <br />Tenant <br />�_.a"L14i�1-f[- � <br />Electrical Contraclor <br />���zc--�7 r��7��yec�r[ lctc��t <br />L �.ira�'� LL�ZL-�% <br />R1ail Addre:s <br />Mail Address <br />__ , / C �J.ri-i' <br />Mail Address <br />� <br />� <br />('r��:(ill C�7��-��CC, _ <br />State License Number <br />Proposed Use of Building <br />Descriplion of Work lo Be Done: . T J— <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 />Cify <br />City <br />Cily <br />,`,r,r <br />State/Zip <br />Stale/Zip <br />Slale/Zip <br />�,_�� CG <br />i5 �-Z-' <br />Contract Price of Work <br />Ptione <br />Phone <br />-'-� �j C S2/ <br />Phone <br />Contacf Person (Plan Review) <br />FEE <br />1 hereby ceriily (hat 1 have read and examined this application and know the same to be true and <br />c�rrecl. All provisions o(la�vs and ordinances governing fhis type of work will be completed <br />whether speci6ed herain or noL The grantin� ol a perrnif does not presume to give authorit, to <br />violate or cancel fhe provisions ol any ofher stafe or local law regu/ating consWction or the <br />performance ol construcGon. That I am authonzed by the owner o/ this property to peAorm the <br />work l�r which applicafion is made and 1 cornply wifh fhe State Contractors Law 18.27 RC W and <br />296.200 WAC. <br />, ' � <br />i <br />-;i <br />'r�=t,4���,�---_ _ i ��� c?� <br />SignaWre �ate <br />/' � �' r �� <br />� � _ <� - <br />;� <br />