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ELECTRICAL PERiVIIT APPLICp►TION <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 />I_1»�[�73i[�7:6'7_1:l�dd�3l��lj:i�7;[•7_1� ii�Zl�� I <br />� �/5 — - �F/`c'( � LA /U�. - l,l ��l T `�C3 <br />PROJECT AUDRESS <br />Owner <br />Mail Address <br />City <br />yzs- <br />�, <br />StatelZip Phone <br />�- �Si��� p S I��OTF�7 f1 D��i'�.SS <br />Tenant Mail Address City SlatelZip Phone <br />Electrical Contracror Mail Address <br />��,���.1 `��1 J/� � <br />State License Number <br />����vu�T�a � <br />Proposed Use of Building <br />Gry <br />; G4lA `l�Z'�0 <br />Stale/Zip <br />Contract Pnce o( Work <br />Ph �ae <br />s7E vt i�rrF�IYI/��1 <br />Contact Person (Plan Review) <br />Descrlption of Work to Be Done �1 �� ��l �� y�' (,�i t.,l / Q/1 z' V��w N�rTPu n� P�, <br />NOTE: WIRING IN NON-DWELLINGS IS REDUIR�U TO <br />BE IN RACEWAYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerLly fhaf I have read nnd exmnmed this apphcafion and know Ihe same lo be true and <br />coneci. AI( piavisrons o/ la�vs and o�dinancr,s govemmg this type ol worN w�ll be compleMd <br />whelirei specd�ed herein o� nof. The gran6ng o/ a permd does not presume lo give aufhority lo <br />violafe o� c�ncel (he provisions ol any olher state or local law regulafiny wnshuclion or the <br />p�rlonnance ol cons(iuclion. That I am au(honzed by fhe owner ol Ihis property fo peAorm Ihe <br />work lor which �ppl�catio., is mado and I cornply �vrth the Sfafe Con(rac(ors Law 1H 27 RCW and <br />29G 200 LVAC. <br />� � � 1 <br />�.i���. ��'���l�Il�� � �o-l��— I� . <br />FEE <br />� Ic�rG-c� � <br />