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ELECiRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.evereltwe.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />7�1�12 i'� vr�r �,� I v.v� ��� r��l �'f'Flz%�� <br />PROJECT ADDRESS <br />Owner <br />� <br />Tenant <br />`� `� -����. <br />Eleclrical Coniraclor <br />��(Z2 QF <br />Mall Addross <br />61ai1 Address <br />� 37i / <br />A1ail Address <br />JP� � I-I�J �- �'- �� L� 1�`A <br />State License Number <br />� <br />lL'�� � i��N �-1 u� L <br />Praposc�d Uso o( Buildin� <br />Description of Work !o Oe Done: �/C'� � <br />NC1TE: WIRING IN NON-DWELLINGS IS REQUIRED TO <br />BE IN RACEV�'AYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />�v�r��N Can- <br />Cily Slate2lp <br />Cily Stale2ip <br />i �./ /l%. �Gt�jL �r� CtY� <br />Phone <br />Phone <br />'l-0 6 <br />%800� ��y� 36�6 <br />Phone <br />����0 �� <br />Contracl Prico ol Work <br />Conlact Person (Plan Review) <br />1 hereby cmtiry Ihat 1 have read und examined this applicntion and know fhe same to be true and <br />correcL All provisions ollaws end ordinunces go��emmq fhis type o( wnrk will be comp/eted <br />whefher spea6eAherein nr not The granfin� of a pernut does nof rosume fo give authonty fo <br />viola(c or cancel fhe provisions oI any other sfate or locnl lnu� rAguYfing construcfion or fhe <br />perlomiance ol construction. That I am autho�ized by the o�rner ol fhis property fo perlomi fhe <br />�vork lor wuich applicafion is mnde and I cornply wifh the Stafe Confrnctors Law 18.27 RCW and <br />296.200 W�IC. <br />� /`''t'� <br />�� �c�l-��v <br />FEE <br />