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ELEC'�'RICAL PERMIT APPLICAT'ION <br />CITI' OF EVERETT PERMIT SERVICES <br />3200 �EDAR STREET, EVERETT, WA 98201 <br />42::-.'5,'-8910 - FAX425-257-8857—www.everettwa.org <br />APPLICATIONS A'r..E ACCEPTED FROM 8 AM TO 4 PM - DC&T 8 CREDIT CAROS AP.E NOT ACCEPTED <br />�.�'I -> I'��- (,_,<-� ,�-� ���� _ <br />PROJECTADDRESS <br />� J i`; L� ._� � 1 ��,,�, ,� �--- <br />Ownef Mad ACAress <br />City <br />StatelZip <br />Phone <br />ienant M,ail AOdress City Sl�to/Zip Phone <br />r/ l,// ���� <�as� <br />f �� ;1 ��, � i lE`( Gd� �� ��JI��'lq � i �(�r��c. 1 � .�.� ) : 7� { i � � <br />7 � � �_� _ � �—�.��—�.L�1�� 2_z_ �.s � <br />EleririCal Conlrada Mail Address City Slata/Zip Phoce <br />f=��, �c,.> �' ���(l �f-',� <br />State License Number <br /><'7- / ) <br />Us: of Bu�'diny <br />Contract Price af Work <br />Contact Perscn (Flan Review) <br />r. / \ <br />C�escription of Work to Be Done: �J`' .�/ C �v�=' �-._> � i, _ <br />NOTE: WIRING �N NON•DWELLINGS IS REOUIRED TO <br />BE IN RACEWAYS, MC OP. AC CABLE. <br />CITY l7F EVERETT LOCAL SALES TAl( CODE IS 3105 <br />! I hereby certdy thaf I have read and c•xanuned th�s application and know the same to be true and <br />j r.orrr:ct. AI! preva�avs ollaws and o�tlinances goveming this type o/ work wdl be completed <br />. �vnether spucdied nerein or not. 7'he gran6ng ol a parmd dces nctp resume to g�ve authonty to <br />'� . iciafe or :: inrel fhe provisions ol any olher state or local law regulating construction or the <br />i performar_e ol corstr�iction. 'ihat I am authonzed by the ownei oI fhis property (o peAorm fhe <br />�,v�rk lor �,hich application �5 rnade and I comply wrth the State Contracters Law iB.27 RCW and <br />j 295.2C0 WAC. <br />�� � <br />� �;��� . �-e�'�' �� <br />�dso3-oi �-I <br />I PE[ <br />