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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMlT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 58201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.ory <br />PROJECT ADDRESS <br />���,�r - .� /� i <br />owner <br />Tenant <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />h�ail Add•ess <br />Mail Address <br />E�ectrir,al Contractor I Mail Address <br />!'-�. 'G'_i,tJc'�' �i��l;"✓7_ <br />S�ate License Number <br />�roposed Use o( Buildinc� <br />Descrption of 'Nork lo Bc Done: <br />NOTE: WIRING LV NON-DWELLINGS IS REQUIRED TO <br />RE IN RACEWAYS, MC Ok AC CAE3LE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />�����, %/� l��n <br />c�iY <br />Cily <br />r'r._ �� �� <br />City <br />E�i� (%�� <br />Stale2ip � Pt.one <br />�/��L/� ��: �. <br />St.�te2ip Phone <br />475 / <br />„� , �, � ., <br />�l�n�-i �•, < <.,r.z . ��- �� i � <br />Stalc/Zip �7'( Phone <br />CoNract Pricc of Work <br />Conlact Person (Plan Review) <br />1 hereGy certily fhaf 1 bave read and examined fhis application and know the sanm fo be Vue and <br />conecf. All provuions ollaws an;l o�dinances go�enuny fhis fype o/ wo�k will be comp/eted <br />whether specilied herein or noL The granting o! a pernuf does nof presume to c�ive au(hority fo <br />violale or cartcel Uie provisions ol any olher stafe orlocal law rec�u/afin� consfruction or fhe <br />per(ormance of consfrucfion. That I am aufhorized by the owner o/ lhis property to perfonn Ihe <br />work lor �vl�ich applicalion is made and 1 comply wilh fhe Sfafe Contracfors La�v 18.27 RCW and <br />29fl 200 WAC. � <br />/ <br />j / , /�/—� <br />c._�)J i .��= �7 ' ? � ' l.' l <br />FEE <br />co5dq-, y7 <br />