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i <br /> ' ELECTRICAL PERMIT APPLICi4TION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www,everettwa.orq <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8� CREDIT CARUS ARE NOT ACCEPTED <br /> �20 I �3!-�K E 2 ,l�v r <br /> PROJECT ADDRESS <br /> Owner M11aJ Address �in, <br /> State2'ip Phone <br /> Tenant Mad Aadress <br /> ��h' SlateiZip F'hone <br /> Snoti.o.ti �.� � r= LSTc- �c P � �4zs-3as- <br /> Electncal Contractur � ��� 2' , � 5+�o ho+.�i�� -� �t� <br /> Mail Atldres, City State/Zip Phone <br /> � v� oko r� ��o P �..J <br /> Statr. LiCense Number <br /> Contract Pnce of Work <br /> S F � <br /> Proposed Use of pwldiny <br /> Comact Pcrson (Plan Revlew) <br /> Description of Work to Be Done� � G�r—p p o� �� <br /> go�e <br /> i N� WIRING IN NON-DWELLINGS IS REOUIRED Tp FEE <br /> , BE IN RACEWAYS, MC OR AC CABLE. <br /> 3� . ��% <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> l hereby certdy thaf f have read and exammed(lus app.hca(ion anA know fhe same to 6e lrue and <br /> corrr.ct. All provrsrons oUaws and ordinances govemmg th/s fype o1 work wdl b� completed <br /> whefher speci�ed herem or neL The granfing of a permd daes nct piesume fo give authonty fo ! <br /> v�olafe or cancel the provis�ons o/any other stafe or Icc�3llaw regu/abny construchon or the I <br /> Pertormance ot construction. That I am authonzed bv fhe owner ol fhis propeRy to pedo�m the <br /> work lor which applica6en is made and I cemply wdfi Lha State Confracrors Law 18 27 RC:V�nd <br /> 29B 00 WAC. <br /> � �� <br /> � ,ature \\\�—=•T�- - <br /> — Date <br /> Q <br /> -------- --- �v�1/ 'C�� <br />