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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 /> � a;E5« DW-1 v'5 <br /> PROJECT ADDRESS <br /> Wit1.{�{�w �►.l�l �D�flIZ �a�y '��.1dE �� � `�� �'`�' �7.5"�yJ�-Izal <br /> Owner Mall Address City Statelzlp Phone <br /> Tenant Mail Address 0ity State/Zip Phone <br /> �1� <br /> c��'-tom ��a►C(�3 '�o -ti 1�t' £�c� 8 <br /> Elecftical Contractor Mail Address te!K12 Phone <br /> State License Number Contract Price of Work <br /> Proposed Use of Building Contact Person (Plan Review) <br /> Square Footage(if residential new construction, remodel or addition) <br /> Description of Work to Be Done: A*_060_ <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CARLe. G�/� ,rin <br /> CITY OF EVI=RETT LOCAL.$ALF$TAX CODE IS 3105 Q I/ lJV <br /> I hereby certify that 1 have read and examined this application and know the same to be true and <br /> correct. All provisions of laws and ordinances goveming this type of work will be completed J�D no� <br /> whether specked herein or not'. The granting of a permit does not presume to give authority to ll (/ <br /> violate or cencei the provisions of any otherstate or local law regulating <br /> pconstruction�the the <br /> performance of co ts made and iacom comply <br /> authorized <br /> the Sthe tate Corti acforrsspLaw 18,2 RCW and <br /> tivorlc for which applicationp Y <br /> 296.200 WAC. <br /> I - Z �-'ZD15 <br /> P <br /> ure Date <br />